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Consulting ‘Dr. Google’ for minimally invasive urological oncological surgeries: A contemporary web-based trend analysis

Int J Med Robot. 2021 Mar 5. doi: 10.1002/rcs.2250. Online ahead of print.


PURPOSE: To determine web-based public interest in minimally invasive surgery (MIS) specifically for urological oncological surgical procedures and how interest in robotics and laparoscopy compares over time.

MATERIALS AND METHODS: Worldwide search-engine trend analysis included electronic Google queries of MIS urologic options from January 2004 to August 2019, worldwide. Join-point regression was performed. Comparison of annual relative search volume (ARSV) and average annual percentage change (AAPC) were analysed to assess loss or gain of interest. Evaluations were made regarding 1) penetrance of interest for MIS in Urology; 2) how MIS urologic procedures compared over time; and 3) which were the top related queries to searches for urologic oncology procedures.

RESULTS: Increased interest was found for all of the MIS procedures evaluated. Mean ARSV for robotic approach was higher for the search term ‘prostatectomy” (44.8 vs. 13.5; p < 0.001) and ‘partial nephrectomy” (27.1 vs.11.5; p = 0.02). No statistical difference was found for the search terms ‘cystectomy” or ‘nephrectomy”. The analysis of mean (∆-ARSV) of MIS procedures measured between the first and last 12 months of the study period showed an increased interest with a more pronounced ∆-ARSV for robotic procedures. The top related searches for all surgical procedures were examined showing an increasing inquisitiveness with regards of type of urological cancers, treatment options, type of surgery and prognostic outcomes.

CONCLUSIONS: People are increasingly searching the web for MIS urological procedures. A growing appeal for robotics is demonstrated, especially for prostatectomy and partial nephrectomy where the robotic approach is gaining traction, suggesting a shift in mind-set amongst people seeking urological healthcare information.

PMID:33667326 | DOI:10.1002/rcs.2250

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Awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women planning surgery for endometriosis: A survey of RANZCOG fellows and trainees

Aust N Z J Obstet Gynaecol. 2021 Mar 5. doi: 10.1111/ajo.13322. Online ahead of print.


BACKGROUND: Endometriosis-specific (advanced gynaecological) ultrasound is recommended as part of preoperative work-up of women with suspected endometriosis.

AIM: To evaluate the awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women with suspected endometriosis among active RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) fellows and trainees.

MATERIALS AND METHODS: Anonymous online survey invitations were emailed to all active RANZCOG fellows in Australia and New Zealand. Descriptive analysis of responses and multivariate analysis where appropriate were performed. P < 0.05 was considered statistically significant.

RESULTS: A 17% (437/2567) survey response rate and 93% (409/437) completion rate were recorded; 59% (248/421) of respondents identified as generalists, whereas 15% (63/421) identified as advanced laparoscopic surgeons. Routine pelvic ultrasound (88.9%, 361/406) was the most common imaging modality requested by respondents; 32% (128/405) of respondents would also always request advanced gynaecology ultrasound. Respondents’ self-reported practice type was significantly associated with utilisation of advanced gynaecological ultrasound (P = 0.03); 79.6% (348/437) agreed with our proposed definition of advanced gynaecological ultrasound for endometriosis. A major limitation to the utilisation of advanced gynaecological ultrasound for endometriosis was the lack of local expertise (63.8%, 233/356).

CONCLUSION: The utilisation of advanced gynaecological ultrasound for endometriosis is significantly influenced by respondents’ self-reported practice type and limited by the lack of local expertise.

PMID:33667321 | DOI:10.1111/ajo.13322

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Prevention of depression in adults with long-term physical conditions

Cochrane Database Syst Rev. 2021 Mar 5;3:CD011246. doi: 10.1002/14651858.CD011246.pub2.


BACKGROUND: Major depression is one of the world’s leading causes of disability in adults with long-term physical conditions compared to those without physical illness. This co-morbidity is associated with a negative prognosis in terms of increased morbidity and mortality rates, increased healthcare costs, decreased adherence to treatment regimens, and a substantial decline in quality of life. Therefore, preventing the onset of depressive episodes in adults with long-term physical conditions should be a global healthcare aim. In this review, primary or tertiary (in cases of preventing recurrences in those with a history of depression) prevention are the focus. While primary prevention aims at preventing the onset of depression, tertiary prevention comprises both preventing recurrences and prohibiting relapses. Tertiary prevention aims to address a depressive episode that might still be present, is about to subside, or has recently resolved. We included tertiary prevention in the case where the focus was preventing the onset of depression in those with a history of depression (preventing recurrences) but excluded it if it specifically focused on maintaining an condition or implementing rehabilitation services (relapse prevention). Secondary prevention of depression seeks to prevent the progression of depressive symptoms by early detection and treatment and may therefore be considered a ‘treatment,’ rather than prevention. We therefore exclude the whole spectrum of secondary prevention.

OBJECTIVES: To assess the effectiveness, acceptability and tolerability of psychological or pharmacological interventions, in comparison to control conditions, in preventing depression in adults with long-term physical conditions; either before first ever onset of depressive symptoms (i.e. primary prevention) or before first onset of depressive symptoms in patients with a history of depression (i.e. tertiary prevention).

SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registries, up to 6 February 2020.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) of preventive psychological or pharmacological interventions, specifically targeting incidence of depression in comparison to treatment as usual (TAU), waiting list, attention/psychological placebo, or placebo. Participants had to be age 18 years or older, with at least one long-term physical condition, and no diagnosis of major depression at baseline (primary prevention). In addition, we included studies comprising mixed samples of patients with and without a history of depression, which explored tertiary prevention of recurrent depression. We excluded other tertiary prevention studies. We also excluded secondary preventive interventions. Primary outcomes included incidence of depression, tolerability, and acceptability. Secondary outcomes included severity of depression, cost-effectiveness and cost-utility.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.

MAIN RESULTS: We included 11 RCTs, with one trial on psychological interventions, and 10 trials on pharmacological interventions. Data analyses on the psychological intervention (problem-solving therapy compared to TAU) included 194 participants with age-related macular degeneration. Data analyses on pharmacological interventions included 837 participants comparing citalopram (one trial), escitalopram (three trials), a mixed sample of fluoxetine/nortriptyline (one trial), melatonin (one trial), milnacipran (one trial), and sertraline (three trials), each to placebo. Included types of long-term physical conditions were acute coronary syndrome (one trial), breast cancer (one trial), head and neck cancer (two trials), stroke (five trials), and traumatic brain injury (one trial). Psychological interventions Very low-certainty evidence of one study suggests that problem solving therapy may be slightly more effective than TAU in preventing the incidence of depression, immediately post-intervention (odds ratio (OR) 0.43, 95% confidence interval (CI) 0.20 to 0.95; 194 participants). However, there may be little to no difference between groups at six months follow-up (OR 0.71, 95% CI 0.36 to 1.38; 190 participants; one study; very low-certainty evidence). No data were available regarding incidence of depression after six months. Regarding acceptability (drop-outs due to any cause), slightly fewer drop-outs occurred in the TAU group immediately post-intervention (OR 5.21, 95% CI 1.11 to 24.40; 206 participants; low-certainty evidence). After six months, however, the groups did not differ (OR 1.67, 95% CI 0.58 to 4.77; 206 participants; low-certainty evidence). This study did not measure tolerability. Pharmacological interventions Post-intervention, compared to placebo, antidepressants may be beneficial in preventing depression in adults with different types of long-term physical conditions, but the evidence is very uncertain (OR 0.31, 95% CI 0.20 to 0.49; 814 participants; nine studies; I2 =0%; very low-certainty evidence). There may be little to no difference between groups both immediately and at six months follow-up (OR 0.44, 95% CI 0.08 to 2.46; 23 participants; one study; very low-certainty evidence) as well as at six to 12 months follow-up (OR 0.81, 95% CI 0.23 to 2.82; 233 participants; three studies; I2 = 49%; very low-certainty evidence). There was very low-certainty evidence from five studies regarding the tolerability of the pharmacological intervention. A total of 669 adverse events were observed in 316 participants from the pharmacological intervention group, and 610 adverse events from 311 participants in the placebo group. There was very low-certainty evidence that drop-outs due to adverse events may be less frequent in the placebo group (OR 2.05, 95% CI 1.07 to 3.89; 561 participants; five studies; I2 = 0%). There was also very low-certainty evidence that drop-outs due to any cause may not differ between groups either post-intervention (OR 1.13, 95% CI 0.73 to 1.73; 962 participants; nine studies; I2 = 28%), or at six to 12 months (OR 1.13, 95% CI 0.69 to 1.86; 327 participants; three studies; I2 = 0%).

AUTHORS’ CONCLUSIONS: Based on evidence of very low certainty, our results may indicate the benefit of pharmacological interventions, during or directly after preventive treatment. Few trials examined short-term outcomes up to six months, nor the follow-up effects at six to 12 months, with studies suffering from great numbers of drop-outs and inconclusive results. Generalisation of results is limited as study populations and treatment regimes were very heterogeneous. Based on the results of this review, we conclude that for adults with long-term physical conditions, there is only very uncertain evidence regarding the implementation of any primary preventive interventions (psychological/pharmacological) for depression.

PMID:33667319 | DOI:10.1002/14651858.CD011246.pub2

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The influence of acute SSRI administration on white matter microstructure in patients suffering from major depressive disorder and healthy controls

Int J Neuropsychopharmacol. 2021 Mar 1:pyab008. doi: 10.1093/ijnp/pyab008. Online ahead of print.


BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are predominantly prescribed for people suffering from major depressive disorder (MDD). These antidepressants exert their effects by blocking the serotonin transporter (SERT) leading to increased levels of serotonin in the synaptic cleft and subsequently to an attenuation of depressive symptoms and elevation in mood. Although long-term studies investigating white matter (WM) alterations after exposure to antidepressant treatment exist, results on the acute effects on the brain’s WM microstructure are lacking.

METHODS: In this interventional longitudinal study, 81 subjects were included (33 patients and 48 healthy controls). All participants underwent diffusion weighted imaging (DWI) on two separate days receiving either citalopram or placebo using a randomized, double-blind, cross-over design. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated within FSL and analysed using tract-based spatial statistics (TBSS).

RESULTS: The repeated measures ANOVA model revealed significant decreases after SSRI administration in MD, AD and RD regardless of the group (p<0.05, FWE-corrected). Results were predominantly evident in frontal WM regions comprising the anterior corona radiata, corpus callosum, external capsule and in distinct areas of the frontal blade. No increases in diffusivity were found and no changes in FA were present.

CONCLUSIONS: Our investigation provides first evidence that fast WM microstructure adaptions within one hour after intravenous SSRI administration precede elevations in mood due to SSRI treatment. These results add a new facet to the complex mode of action of antidepressant therapy. This study was registered at with the identifier NCT02711215.

PMID:33667309 | DOI:10.1093/ijnp/pyab008

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Outcome of the frozen elephant trunk procedure as a redo operation

Interact Cardiovasc Thorac Surg. 2021 Mar 1:ivab059. doi: 10.1093/icvts/ivab059. Online ahead of print.


OBJECTIVES: The goal of this study was to determine the outcome of patients undergoing an elective frozen elephant trunk (FET) procedure as a redo operation following previous cardiac surgery.

METHODS: One hundred and eighteen consecutive patients underwent FET procedures between October 2010 and October 2019 at our centre. Patients were registered in a dedicated database and analysed retrospectively. Clinical and follow-up characteristics were compared between patients undergoing a FET operation as a primary (primary group) or a redo procedure (redo group) using logistic regression and Cox regression analysis. Emergency procedures (n = 33) were excluded from the analysis.

RESULTS: A total of 36.5% (n = 31) of the FET procedures were redo operations (redo group) and 63.5% (n = 54) of the patients underwent primary surgery (primary group). There was no significant difference in the 30-day mortality [primary group: 7.4%; redo group: 3.2%; 95% confidence interval (CI) (0.19-35.29); P = 0.63] and the 3-year mortality [primary group: 22.2%; redo group: 16.7%; 95% CI (0.23-3.23); P = 0.72] between redo and primary cases. Furthermore, the adjusted statistical analysis did not reveal significant differences between the groups in the occurrence of transient or permanent neurological deficit, paraplegia, acute renal failure and resternotomy. The redo group showed a higher rate of recurrent nerve palsy, which did not reach statistical significance [primary group: 3.7% (n = 2); redo group: 19.4% (n = 6); P = 0.091].

CONCLUSIONS: Elective FET procedures as redo operations performed by a dedicated aortic team following previous cardiac surgery demonstrate an adequate safety profile.

PMID:33667306 | DOI:10.1093/icvts/ivab059

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Comparison of safety and effectiveness between 23-gauge and 25-gauge vitrectomy surgery in common vitreoretinal diseases

PLoS One. 2021 Mar 5;16(3):e0248164. doi: 10.1371/journal.pone.0248164. eCollection 2021.


PURPOSE: To assess and compare safety and effectiveness between 23-gauge and 25-gauge vitrectomy systems for the treatment of common vitreoretinal diseases in non-vitrectomized eyes.

METHODS: Retrospective evaluation of patients who underwent pars plana vitrectomy from April 2018 to December 2019 at the Department of Ophthalmology and Optometry at the Medical University of Vienna (MUV) for the following indications: macular epiretinal membrane, macular hole, macular lamellar hole, vitreous hemorrhage, vitreous opacities, vitreomacular traction syndrome and macular edema.

RESULTS: 201 eyes of 195 patients that underwent 23-gauge (n = 105 eyes) or 25-gauge (n = 96 eyes) vitrectomy were included in this study. The mean best-corrected visual acuity (BCVA) improved at 1-3 months postoperatively and beyond 3 months in both gauge groups. Risk of any complication within 1 month postoperatively was lower in the 25-gauge group, but the difference was statistically not significant (HR [95% CI]: 0.95 [0.53; 1.70], p = 0.85). Intraocular pressure less than 5 mmHg was observed in 2 eyes (2%) in the 23-gauge group at the first postoperative day. Intraocular pressure elevation over 25 mmHg occurred in 5 eyes (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group) at postoperative day 1, between 7 and 28 days in 5 cases (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group), and in 2 eyes (2%) of the 23-gauge group at postoperative day 145 and 61, respectively. Retinal detachment occurred in 1 eye (1%) in the 23-gauge and in 3 eyes (3%) in the 25-gauge group. We did not observe any cases of endophthalmitis.

CONCLUSION: Results in terms of safety, surgical success and visual outcomes for the treatment of common vitreoretinal surgery indications seem to be comparable between 23-gauge and 25-gauge vitrectomy systems, indicating that the two gauge systems can be used equally in the clinical routine.

PMID:33667273 | DOI:10.1371/journal.pone.0248164

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Genetic impacts on thermostability of onco-lncRNA HOTAIR during the development and progression of endometriosis

PLoS One. 2021 Mar 5;16(3):e0248168. doi: 10.1371/journal.pone.0248168. eCollection 2021.


HOTAIR is a well-known long non-coding RNA (lncRNA) involved in various cellular signaling, whereas its functional impacts on endometriosis development are still largely unknown. To this end, six potential functional single nucleotide polymorphisms (SNPs) in HOTAIR, with minor allele frequencies more than 10% in Han population and altered net energy of RNA structures larger than 0.5 kcal/mol, were selected for genotyping study. The study included 207 endometriosis patients and 200 healthy women. Genetic substitutions at rs1838169 and rs17720428 were frequently found in endometriosis patients, and rs1838169 showed statistical significance (p = 0.0174). The G-G (rs1838169-rs17720428) haplotype showed the most significant association with endometriosis (p < 0.0001) with enhanced HOTAIR stability, and patients who harbor such haplotype tended to show higher CA125. Data mining further revealed higher mRNA HOTAIR levels in the endometria of patients with severe endometriosis which consistently showed reduced HOXD10 and HOXA5 levels. HOTAIR knockdown with specific shRNAs down-regulated cell proliferation and migration with the induction of HOXD10 and HOXA5 expression in human ovarian clear cancer cells. Our study therefore provided evidence to indicate a prominent role of HOTAIR in promoting endometriosis, which could be used as a potential target for clinical applications.

PMID:33667269 | DOI:10.1371/journal.pone.0248168

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Piscirickettsia salmonis shedding and tissue burden, and hematological responses during cohabitation infections in chum Oncorhynchus keta, pink O. gorbuscha and Atlantic salmon Salmo salar

PLoS One. 2021 Mar 5;16(3):e0248098. doi: 10.1371/journal.pone.0248098. eCollection 2021.


BACKGROUND: Salmonid rickettsial septicemia is an emergent and geographically widespread disease of marine-farmed salmonids caused by infection with the water-borne bacterium Piscirickettsia salmonis. Very little is known about the route, timing, or magnitude of bacterial shedding from infected fish.

METHODOLOGY/PRINCIPAL FINDINGS: A cohabitation challenge model was used to assess shedding from chum Oncorhynchus keta, pink O. gorbuscha and Atlantic salmon Salmo salar. Infections in donor fish were established by intraperitoneal injection of P. salmonis. Naïve recipients were cohabitated with donor fish after which cumulative percent morbidity and mortality (CMM) was monitored, and bacterial burdens in kidney and in tank water were measured by qPCR. All donor fish died with mean days-to-death (MDD) among species ranging from 17.5 to 23.9. Among recipients, CMM ranged from 42.7% to 77.8% and MDD ranged from 49.7 to 56.4. In each trial, two peaks of bacterial DNA concentrations in tank water closely aligned with the MDD values of donor and recipient fish. Bacterial tissue burden and shedding rate, and plasma physiological parameters were obtained from individual donors and recipients. Statistically significant positive correlations between the shedding rate and P. salmonis kidney burden were measured in donor pink and in donor and recipient chum salmon, but not in donor or recipient Atlantic salmon. In Atlantic salmon, there was a negative correlation between kidney bacterial burden and hematocrit, plasma Ca++ and Mg++ values, whereas in infected chum salmon the correlation was positive for Na+ and Cl- and negative for glucose.

CONCLUSIONS: A dependency of bacterial shedding on species-specific patterns of pathogenesis was suggested. The coincidence of bacterial shedding with mortality will inform pathogen transmission models.

PMID:33667267 | DOI:10.1371/journal.pone.0248098

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Prognostic significance of estrogen, progesterone and HER2 receptors’ status conversion following neoadjuvant chemotherapy in patients with locally advanced breast cancer: Results from a tertiary Cancer Center in Saudi Arabia

PLoS One. 2021 Mar 5;16(3):e0247802. doi: 10.1371/journal.pone.0247802. eCollection 2021.


BACKGROUND: The prognostic impact of neoadjuvant chemotherapy (NAC) on the receptor expression status in patients with locally advanced breast cancer (LABC) is still not fully understood. We aimed to evaluate the changes in hormone (estrogen and progesterone) receptor (HR) and human epidermal growth factor receptor 2 (HER2) status post-NAC and their correlation with survival.

METHODS: Patients with LABC who have received NAC between 2008 and 2015 and have been followed up till December 2019 at the Oncology Center, King Saud University, KSA were analyzed retrospectively. biomarker analysis of ER, PR & HER2 were done using immunohistochemistry (IHC) and Fluorescent in situ hybridization.

RESULTS: Ninety-one patients fulfilled the inclusion criteria. HR status changed in 21(23.1%) patients, with a significant difference between patients with stable receptors and those with any receptor conversion; p = 0.000. Five (5.5%) initially HER2 negative tumors became HER2 positive and 10 (11%) initially HER2 positive tumors became HER2 negative after NAC. The difference in HER2 expression level before and after NAC was not statistically significant (p = 0.302). Univariate analysis relating patients’ characteristics and 10-years disease-free survival (DFS) showed only significant correlations with the expressions of ER, PR, and any receptor conversion, (ER and/or PR) p< 0.001, p< 0.001, and p = 0.001; respectively. In the univariate analysis, none of the clinicopathological features showed a significant correlation with the OS except for the molecular subtypes P<0.001.

CONCLUSIONS: Patients with LABC have significant changes in the ER and PR receptor status following NAC. Post-NAC expressions change of ER and PR (ER and/or PR) are correlated to DFS. Retesting of the hormone receptors should be considered after NAC in Saudi patients with LABC.

PMID:33667252 | DOI:10.1371/journal.pone.0247802

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Health-related quality of life and associated factors among people living with human immunodeficiency virus on highly active antiretroviral therapy in North East Ethiopia: Cross-sectional study

PLoS One. 2021 Mar 5;16(3):e0247777. doi: 10.1371/journal.pone.0247777. eCollection 2021.


INTRODUCTION: HIV/AIDS remains a public health concern affecting millions of people across the world. Although the health-related quality of life (HRQoL) of patients living with HIV has significantly improved after treatment, its chronicity makes the HRQoL uncertain. This study assessed factors associated with the health-related quality of life among people living with HIV/AIDS on HAART in North-East Ethiopia.

METHODS: An institutional-based cross-sectional study was conducted from March to April 2018, and systematic random sampling was used to select 235 participants who were on HAART. HRQoL was assessed using the Medical Outcomes Study HIV Health Survey. Descriptive and multiple linear regression analysis were computed using the statistical package for social sciences version 20.

RESULTS: The study revealed one-factor structure and had good overall internal consistency (78.5). Over one-third (42.6%; 95% CI; 36.2%, 48.9%) of participants had good HRQoL. The least HRQoL mean score was found for cognitive functioning 32.21(±19.78), followed by social functioning 40.58(±29.8). Factors associated with the overall HRQoL were 25-45 years of age (β = – 3.55, 95% CI;-6.54, -0.55), working in private sector (β = -5.66, 95% CI;-9.43, -1.88), government (β = -4.29, 95% CI;-7.83, -0.75) and self-employment (β = -8.86, 95% CI;-13.50, -4.21), 100-200 (β = – 4.84, 95% CI;-9.04, -0.63) and 201-350 CD4 at the time of diagnosis (β = – 7.45, 95% CI;-11.73, -3.16), 351-500 current CD4 level (β = 8.34, 95% CI;5.55, 11.41), 6-10 years of disease duration (β = -8.28, 95% CI;-12.51, -4.04), WHO stage II (β = -4.78, 95% CI;-8.52, -1.04) and III (β = 3.42, 95% CI;0.06, 6.79) during treatment initiation and not taking of Cotrimoxazole prophylaxis (β = -5.79, 95% CI;-8.34, -3.25).

CONCLUSIONS: High proportion of participants had a poor HRQoL. Routine assessment and appropriate interventions at each visit is recommended to improve HRQoL.

PMID:33667245 | DOI:10.1371/journal.pone.0247777