Nevin Manimala

Breast Cancer Res Treat. 2023 Dec 22. doi: 10.1007/s10549-023-07178-6. Online ahead of print.

ABSTRACT

PURPOSE: In breast cancer, neoadjuvant chemotherapy (NAC) can downstage the nodal status, and can even result in a pathological complete response, which is associated with improved prognosis. This study aimed to determine the prognostic effect of nodal status before and after NAC.

METHODS: Women with breast cancer treated with NAC were selected from the Netherlands Cancer Registry if diagnosed between 2005 and 2019, and classified based on nodal status before NAC: node-negative (cN0), or node-positive based on fine needle aspiration cytology or core needle biopsy (cN+). Subgroups were based on nodal status after NAC: absence (ypN0) or presence (ypN+) of nodal disease. Five-year overall survival (OS) was assessed with Kaplan-Meier survival analyses, also per breast cancer molecular subtype. To adjust for potential confounders, multivariable analyses were performed.

RESULTS: A total of 6,580 patients were included in the cN0 group, and 11,878 in the cN+ group. The 5-year OS of the cN0ypN0-subgroup was statistically significant better than that of the cN+ypN0-subgroup (94.4% versus 90.1%, p < 0.0001). In cN0 as well as cN+ disease, ypN+ had a statistically significant worse 5-year OS compared to ypN0. For hormone receptor (HR)+ human epidermal growth factor receptor 2 (HER2)-, HR+ HER2+, HR-HER2+, and triple negative disease, respectively, 5-year OS in the cN0ypN+-subgroup was 89.7%, 90.4%, 73.7%, and 53.6%, and in the cN+ypN+-subgroup 84.7%, 83.2%, 61.4%, and 48.8%. In multivariable analyses, cN+ and ypN+ disease were both associated with worse OS.

CONCLUSION: This study suggests that both cN-status and ypN-status, and molecular subtype should be considered to further improve prognostication.

PMID:38133707 | DOI:10.1007/s10549-023-07178-6

Lasers Med Sci. 2023 Dec 22;39(1):12. doi: 10.1007/s10103-023-03957-1.

ABSTRACT

Leprosy is a chronic infectious disease characterized by acute inflammatory episodes that affect the skin and peripheral nerves and can develop progressive and irreversible disabilities and deformities. In addition, drug therapy and physiotherapy offer resources and techniques capable of mitigating the consequences of neural lesions, but neural lesions can occur before, during, and even after drug treatment. Thus, new treatments are needed. Photobiomodulation (PBM) might be a promissor therapy since it aims to reduce the inflammatory process and restore motor and sensory functions in the affected area. This study aims to compare the evolution of neural status, pain, and functionality in patients with leprosy and neuritis after a physiotherapeutic protocol and PBM treatment. This was a randomized controlled clinical trial that analyzed a group of patients receiving a physiotherapeutic protocol (PPG) and another receiving physiotherapeutic protocol associated with PBM (PLG) (wavelength 904 nm, potency 70 mW, time per point 9 s). Our results showed when evaluating functional capacity limitations with the SALSA scale, the PLG patients improved from moderate to mild limitations. On the other hand, the PPG remained as moderate limitations. Also, the PLG showed a significant reduction in pain on the VAS scale. The neurological assessment showed that PLG improved palpation of the median, radial, and peroneal nerves. In the strength test, PLG patients improved in the 5th finger abduction and ankle dorsiflexion. Assessing sensitivity, it was identified an improvement in PLG for the ulnar nerve and tibial nerve. All those changes were statistically significant when compared to the PPG patients. Finally, the PLG patients improved disabilities, identified by the neurological assessment of the eyes, hands, and feet. In conclusion, this study demonstrated that combining a physiotherapeutic protocol with PBM treatment effectively improved functional status and reduced pain in leprosy patients.

PMID:38133695 | DOI:10.1007/s10103-023-03957-1

AIDS. 2023 Dec 22. doi: 10.1097/QAD.0000000000003824. Online ahead of print.

ABSTRACT

BACKGROUND: While recognized as a key HIV prevention strategy, preexposure prophylaxis (PrEP) availability and accessibility are not well documented globally. We aimed to describe PrEP drug registration status and the availability of PrEP services across HIV care sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium.

METHODS: We used country-level PrEP drug registration status from the AIDS Vaccine Advocacy Coalition and data from IeDEA surveys conducted in 2014, 2017 and 2020 among participating HIV clinics in seven global regions. We used descriptive statistics to assess PrEP availability across IeDEA sites serving adult patients in 2020 and examined trends in PrEP availability among sites that responded to all three surveys.

RESULTS: Of 199 sites that completed the 2020 survey, PrEP was available in 161 (81%). PrEP availability was highest at sites in North America (29/30; 97%) and East Africa (70/74; 95%) and lowest at sites in Central (10/20; 50%) and West Africa (1/6; 17%). PrEP availability was higher among sites in countries where PrEP was officially registered (146/161; 91%) than where it was not (14/32; 44%). Availability was higher at health centers (109/120; 90%) and district hospitals (14/16; 88%) compared to regional/teaching hospitals (36/63). Among the 94 sites that responded to all three surveys, PrEP availability increased from 47% in 2014 to 60% in 2017 and 76% in 2020.

CONCLUSION: PrEP availability has substantially increased since 2014 and is now available at most IeDEA sites. However, PrEP service provision varies markedly across global regions.

PMID:38133656 | DOI:10.1097/QAD.0000000000003824

Eur J Orthop Surg Traumatol. 2023 Dec 22. doi: 10.1007/s00590-023-03798-2. Online ahead of print.

ABSTRACT

OBJECTIVES: Robotic knee arthroplasty procedures have emerged as a new trend, garnering attention from orthopedic surgeons globally. It has been hypothesized that the use of robotics enhances the accuracy of prosthesis positioning and alignment restoration. The objective of this study was to provide a high-level, evidence-based comparison between robotic total knee replacements and conventional methods, focusing on radiological and functional outcomes.

METHODS: We searched five databases from their inception until June 1, 2022, specifically targeting randomized controlled trials (RCTs) that compared the outcomes of robotic and conventional total knee replacements. We were interested in outcomes such as knee range of motion, clinical and function knee society scores, the Western Ontario and McMaster University score (WOMAC), the Hospital of Special Surgery score, complications, and radiological alignment. This review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. We assessed the risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).

RESULTS: Our search returned seven RCTs suitable for our analysis, which included a total of 1942 knees; 974 of these knees were implanted using robotic arms while the remaining 968 utilized jig-based knee systems. Our findings indicated that robotic knees had significantly better post-operative anatomical (OR – 0.82; 95% CI, – 1.027 to – 0.58, p value < 0.00001) and mechanical restoration (OR – 0.95; 95% CI, – 1.49 to – 0.41, p value < 0.0006). While knee range of motion (OR – 2.23; 95% CI – 4.89-0.43, p value 0.1) and femoral prosthesis position (OR – 0.98; 95% CI, – 2.03-0.08, p value 0.07) also favored robotic knees, these differences did not reach statistical significance. Both clinical and functional outcomes, as well as the rate of complications, were found to be statistically similar between the groups undergoing robotic and traditional knee replacement surgeries.

CONCLUSION: This meta-analysis indicates that robotic total knee replacements offer superior post-operative anatomical and mechanical alignment compared to conventional total knee replacements. Despite this, clinical and functional outcomes, as well as complication rates, were similar between the two. These findings should be considered in light of potential confounding factors. More randomized controlled trials with the latest robotic systems are needed to confirm any superior functional and clinical outcomes from robotic-assisted surgeries.

LEVEL OF EVIDENCE: I.

PMID:38133653 | DOI:10.1007/s00590-023-03798-2

Ophthalmic Plast Reconstr Surg. 2023 Dec 19. doi: 10.1097/IOP.0000000000002574. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to demonstrate the performance of the popular artificial intelligence (AI) language model, Chat Generative Pre-trained Transformer (ChatGPT) (OpenAI, San Francisco, CA, U.S.A.), in generating the informed consent (IC) document of blepharoplasty.

METHODS: A total of 2 prompts were provided to ChatGPT to generate IC documents. Four board-certified plastic surgeons and 4 nonmedical staff members evaluated the AI-generated IC documents and the original IC document currently used in the clinical setting. They assessed these documents in terms of accuracy, informativeness, and accessibility.

RESULTS: Among board-certified plastic surgeons, the initial AI-generated IC document scored significantly lower than the original IC document in accuracy (p < 0.001), informativeness (p = 0.005), and accessibility (p = 0.021), while the revised AI-generated IC document scored lower compared with the original document in accuracy (p = 0.03) and accessibility (p = 0.021). Among nonmedical staff members, no statistical significance of 2 AI-generated IC documents was observed compared with the original document in terms of accuracy, informativeness, and accessibility.

CONCLUSIONS: Our results showed that current ChatGPT cannot be used as a distinct patient education resource. However, it has the potential to make better IC documents when improving the professional terminology. This AI technology will eventually transform ophthalmic plastic surgery healthcare systematics by enhancing patient education and decision-making via IC documents.

PMID:38133626 | DOI:10.1097/IOP.0000000000002574

J Acquir Immune Defic Syndr. 2023 Dec 22. doi: 10.1097/QAI.0000000000003365. Online ahead of print.

ABSTRACT

BACKGROUND: Approximately two in five persons with HIV (PWH) in the United States are aged ≥55 years. HIV ancillary services, such as case management and transportation services, can help older PWH remain engaged in care. We used data from the Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged ≥55 years.

SETTING: Medical Monitoring Project is an annual cross-sectional study that reports representative estimates on adults with diagnosed HIV in the United States.

METHODS: We used MMP data collected during 6/2019-5/2021 to calculate weighted percentages of cisgender men and cisgender women with HIV aged ≥55 years with unmet needs for ancillary services, overall and by selected characteristics (N=3,200). Unmet need was defined as needing but not receiving a given ancillary service. We assessed differences between groups using prevalence ratios (PRs) and 95% confidence intervals (CIs) with predicted marginal means.

RESULTS: Overall, 37.7% of cisgender men and women with HIV aged ≥55 years had ≥1 unmet need for ancillary services. Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services. There were no statistically significant differences in unmet needs for services by gender. The prevalence of ≥1 unmet need was higher among non-White persons (PR range: 1.35-1.63), persons who experienced housing instability (PR=1.70), and those without any private insurance (PR range: 1.49-1.83).

CONCLUSION: A large percentage of older PWH have unmet needs for ancillary services. Given the challenges that older PWH face related to the interaction of HIV and aging-associated factors, deficits in the provision of ancillary services should be addressed.

PMID:38133575 | DOI:10.1097/QAI.0000000000003365

Epilepsia Open. 2023 Dec 22. doi: 10.1002/epi4.12890. Online ahead of print.

ABSTRACT

OBJECTIVE: Rescue benzodiazepine medication can be used to treat seizure clusters, which are intermittent, stereotypic episodes of frequent seizure activity that are distinct from a patient’s usual seizure pattern. The NeuroPace RNS® System is a device that detects abnormal electrographic activity through intracranial electrodes and administers electrical stimulation to control seizures. Reductions in electrographic activity over days to weeks have been associated with the longer-term efficacy of daily antiseizure medications (ASMs). In this pilot study, electrographic activity over hours to days was examined to assess the impact of a single dose of a proven rescue therapy (diazepam nasal spray) with a rapid onset of action.

METHODS: Adult volunteers (>18 years old) with clinically indicated RNS (stable settings and ASM usage) received a weight-based dose of diazepam nasal spray in the absence of a clinical seizure. Descriptive statistics for number of detections and sum of durations of detections at 10-minute, hourly, and 24-hour intervals during the 7-day (predose) baseline period were calculated. Post-dose detections at each time interval were compared with the respective baseline-detection intervals using a 1 SD threshold. The number of long episodes that occurred after dosing also were compared with baseline.

RESULTS: Five participants were enrolled, and 4 completed the study; the excluded participant had recurrent seizures during the study. There were no consistent changes (difference >1 SD) in detections between post-dose and mean baseline values. Although variability was high (1 SD was often near or exceeded the mean), 3 participants showed possible trends for reductions in one or more electrographic variables following treatment.

SIGNIFICANCE: RNS-assessed electrographic detections and durations were not shown to be sensitive measures of short-term effects associated with a single dose of rescue medication in this small group of participants. It is possible the variability of detections may have masked a measurable drug effect.

PMID:38131286 | DOI:10.1002/epi4.12890

J Med Radiat Sci. 2023 Dec 22. doi: 10.1002/jmrs.745. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients undergoing radiation therapy have a diverse range of information needs, however, there is a lack of data specific to the needs of New Zealand patients. This cross-sectional survey captured New Zealand cancer patients’ preferences for radiation treatment information. Preferences were assessed regarding the scope of information needs and the satisfaction with which these needs were being met.

METHODS: A custom survey was offered to 275 eligible patients undergoing radiation treatment at six of 10 departments across New Zealand over a 2-day period. The survey captured patient demographics as well as information needs and satisfaction across five distinct domains using Likert scales and one free-text question. Responses were analysed using descriptive statistics and directed content analysis.

RESULTS: Over 80% of participants rated all information domains as extremely or very important. Over 90% of participants were extremely satisfied or very well satisfied in four of the five domains. Information on what happens after radiation treatment had the lowest satisfaction at 78%. No demographic subcategories were clearly associated with differences in information needs or satisfaction. 59% of participants indicated their willingness to engage in online education. The qualitative analysis strongly corroborated the quantitative results.

CONCLUSION: The New Zealand cancer patients surveyed in this study demonstrated high levels of importance and satisfaction with the information provided during radiation treatment. Information on what happens after completing radiation treatment had the lowest satisfaction. These findings support further exploration of New Zealand cancer patients’ information needs following radiation treatment as well as strategies to address them.

PMID:38131264 | DOI:10.1002/jmrs.745

J Vet Intern Med. 2023 Dec 22. doi: 10.1111/jvim.16974. Online ahead of print.

ABSTRACT

BACKGROUND: Hypercalcemia of malignancy (HM) secondary to lymphoma in dogs has the potential to cause renal injury.

HYPOTHESIS/OBJECTIVES: Characterize outcomes related to acute kidney injury (AKI) secondary to HM. We hypothesized that dogs do suffer AKI regardless of HM severity at the time of lymphoma diagnosis or relapse.

ANIMALS: Retrospective study. Twenty-nine dogs with lymphoma, HM, and azotemia (International Renal Interest Society [IRIS] grade II or higher AKI) that underwent chemotherapy were identified at 2 veterinary institutions.

METHODS: Logistic regression and descriptive statistical analysis were performed to evaluate data for potential prognostic factors.

RESULTS: After initiating treatment, resolution of hypercalcemia and azotemia occurred in 100% (29/29) and 79.3% (23/29) of dogs, respectively. Resolution of azotemia was influenced by serum creatinine concentration (odds ratio [OR], 0.148; Confidence interval [CI], 0.03-0.734; P = .02) and total hypercalcemia (OR, 0.36; CI, 0.14-0.93; P = .04) at diagnosis, whereas blood urea nitrogen concentration, IRIS grade, sex, and whether or not dogs were hospitalized were not significant factors. At data analysis, 13.8% (4/29) of dogs were alive or lost to follow-up. Of those dead, 4 dogs (15%) had renal disease at the time of death, 2/4 having concurrent lymphoma progression.

CONCLUSIONS AND CLINICAL IMPORTANCE: Although AKI may be of clinical concern in dogs with HM secondary to lymphoma at diagnosis, death secondary to renal impairment appears to be infrequent.

PMID:38131263 | DOI:10.1111/jvim.16974

Aust Dent J. 2023 Dec 22. doi: 10.1111/adj.13004. Online ahead of print.

ABSTRACT

BACKGROUND: Clinical practitioners may have become familiar with the rapid transformation of dental composites. However, they may not scientifically understand the factors influencing the mechanical and physical properties. Scientific knowledge of filler-resin interaction can significantly improve clinical understanding of resin composites. Several independent studies have examined the mechanical and physico-mechanical properties of dental resin composites; however, no comprehensive study has examined the influence of fillers and resin materials on the physico-mechanical properties of both self-cure and dual-cure composites.

METHODS: This study performed investigations on the physico-mechanical behaviour of four commercially available dual-cure dental composites (Bioactive, Fill Up!, Surefil One, Cention N) and two commercially available self-cure dental composites (Stela Capsule and Stela Automix). Test specimens for flexural and compressive strength, microhardness, fracture toughness, and hydrolytic behaviour were prepared and tested as per respective standards. The data sets were statistically analysed using one-way ANOVA and Tukey’s post-hoc comparison.

RESULTS: There was a substantial variation in flexural strength and modulus values in this study, ranging from 32.0 to 113.4 MPa and 2.36 to 12.07 GPa, respectively. Similarly, there were significant differences in compressive strength between the materials in this study, ranging from 119.3 to 223.5 MPa. The highest fracture toughness value was found to be 1.41 MPa.m^0.5 , while the lowest value was 0.43 MPa.m^0.5 . Variations in surface microhardness were significant (24.11-68.0 N/mm² ), which correlated with the filler content. Water sorption and solubility demonstrated high variations among materials, with Surefil One exceeding ISO 4049 thresholds significantly.

CONCLUSIONS: A linear correlation can be established between surface microhardness (HV) and flexural and compressive moduli, as well as filler content (wt.%). However, both flexural and compressive strengths are impacted by the resin’s constituent monomers and the resin-filler matrix’s cross-linking capability. Additionally, factors such as filler size, shape, and the cross-linking ability of the resin-filler matrix play a crucial role in fracture toughness and the propagation of cracks within the restoration. Also, resin monomers and filler particle size affect the hydrolytic degradation characteristics of composites, which can also affect their mechanical properties. © 2023 Australian Dental Association.

PMID:38131257 | DOI:10.1111/adj.13004