Nevin Manimala

JCO Oncol Pract. 2023 Feb 10:OP2200349. doi: 10.1200/OP.22.00349. Online ahead of print.

ABSTRACT

PURPOSE: Fertility discussions are an integral part of comprehensive care for pediatric, adolescent, and young adult patients newly diagnosed with cancer and are supported by national guidelines. Current institutional practices are poorly understood.

METHODS: A cross-sectional survey was distributed to 220 Children’s Oncology Group member institutions regarding fertility discussion practices. Descriptive statistics were calculated for all variables. The association between specific practices and selected outcomes on the basis of sex was examined via multivariable logistic regression.

RESULTS: One hundred forty-four programs (65.5%) returned surveys. Of these, 65 (45.1%) reported routine discussions of fertility with all female patients and 55 (38.5%) all male patients (P = .25). Ninety-two (63.8%) reported no specific criteria for offering females fertility preservation (FP), compared with 40 (27.7%) for males (P < .001). Program characteristics associated with fertility discussions included reproductive endocrinology and infertility on site (females odds ratio [OR], 2.1; 95% CI, 1.0 to 4.3), discussion documentation mandate (females OR, 2.3; 95% CI, 1.0 to 5.5; males OR, 3.5; 95% CI, 1.4 to 8.7), and cumulative institution-based FP infrastructure (which included [1] routine practice of documentation, [2] template for documentation, [3] mandate for documentation, and [4] availability of FP navigation; females OR, 1.6; 95% CI, 1.1 to 2.3; males OR, 2.3; 95% CI, 1.6 to 3.4). Utilization of practices unsupported by guidelines included offering sperm banking after treatment initiation (39/135 programs; 28.9%), gonadotropin-releasing hormone analogs for ovarian suppression/FP (75/144 programs; 52.1%), ovarian tissue cryopreservation at diagnosis for patients with leukemia (19/64 programs; 29.7%), and testicular tissue cryopreservation (23/138 programs; 16.7%) not part of a clinical trial.

CONCLUSION: Despite recommended guidelines, fertility discussions with patients/families before treatment initiation are not routine at Children’s Oncology Group institutions. Standard criteria to determine which options should be offered to patients are more common for males than females.

PMID:36763922 | DOI:10.1200/OP.22.00349

J Sex Med. 2023 Jan 12:qdac022. doi: 10.1093/jsxmed/qdac022. Online ahead of print.

ABSTRACT

BACKGROUND: Phalloplasty is a challenging procedure in the field of repair and reconstruction. Traditional skin flap methods with prostheses or autologous tissue implantation are still common; however, with this method the reconstructed phallus is static and has a high risk of complications.

AIM: We aimed to use novel methods for phalloplasty to mimic the normal structure of the phallus while maintaining the patient’s ability to obtain sufficient hardness and subjective controllability.

METHODS: The neophallus comprised the bilateral pedicled neurovascular gracilis muscle, which provided neophallus volitional control; the pedicled fascia lata, which mimicked the tunica albuginea; the pedicled anterolateral thigh flap, which was used to reconstruct the neourethra and neoglans; and the thin split-thickness skin grafted on the surface of the fascia lata. The urethral anastomosis was performed simultaneously. The appearance and function of the neophallus, as well as patient satisfaction, were evaluated postoperatively.

OUTCOMES: The biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata was successfully performed in 4 patients.

RESULTS: During follow-up at 10-21 months after the procedure, all 4 patients could complete sexual intercourse and were satisfied with the appearance and self-controllability of the neophallus. The size of the neophallus stabilized within 6 months. The tactile, deep touch sensation, and pain sensations of the neophallus partially recovered. All of the patients could stand to urinate.

CLINICAL IMPLICATIONS: We used the gracilis muscle combined with the fascia lata to mimic the basic structure of the corpus cavernosum and tunica albuginea and successfully reconstructed the biomimetic dynamic neophallus.

STRENGTHS AND LIMITATIONS: This is to our knowledge the first report of biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata to mimic the complex structure of the phallus and enable the achievement of erection. However, due to the small number of patients included in this study, the data have no statistical significance. More cases are needed to obtain conclusive data and examine the long-term clinical effects of this procedure.

CONCLUSION: Using novel methods for phalloplasty, we successfully maintained the patient’s ability to obtain sufficient hardness and subjective controllability without the use of implants, and the preliminary clinical results are encouraging.

PMID:36763921 | DOI:10.1093/jsxmed/qdac022

Magn Reson Med. 2023 Feb 10. doi: 10.1002/mrm.29614. Online ahead of print.

ABSTRACT

PURPOSE: To describe an inversion-recovery T₁ -weighted radial stack-of-stars 3D gradient echo (GRE) sequence with comparable image quality to conventional MP-RAGE and to demonstrate how the radial acquisition scheme can be utilized for additional retrospective motion correction to improve robustness to head motion.

METHODS: The proposed sequence, named MP-RAVE, has been derived from a previously described radial stack-of-stars 3D GRE sequence (RAVE) and includes a 180° inversion recovery pulse that is generated once for every stack of radial views. The sequence is combined with retrospective 3D motion correction to improve robustness. The effectiveness has been evaluated in phantoms and healthy volunteers and compared to conventional MP-RAGE acquisition.

RESULTS: MP-RAGE and MP-RAVE anatomical images were rated “good” to “excellent” in overall image quality, with artifact level between “mild” and “no artifacts”, and with no statistically significant difference between methods. During head motion, MP-RAVE showed higher inherent robustness with artifacts confined to local brain regions. In combination with motion correction, MP-RAVE provided noticeably improved image quality during different head motion and showed statistically significant improvement in image sharpness.

CONCLUSION: MP-RAVE provides comparable image quality and contrast to conventional MP-RAGE with improved robustness to head motion. In combination with retrospective 3D motion correction, MP-RAVE can be a useful alternative to MP-RAGE, especially in non-cooperative or pediatric patients.

PMID:36763847 | DOI:10.1002/mrm.29614

Spine (Phila Pa 1976). 2023 Feb 10. doi: 10.1097/BRS.0000000000004597. Online ahead of print.

ABSTRACT

STUDY DESIGN: A retrospective cohort study.

OBJECTIVE: To determine if there a difference in reoperation rates for symptomatic adjacent segment disease (operative ASD) and symptomatic nonunions (operative nonunions) in posterior cervical fusions (PCFs) stopping at C7 using either lateral mass screws (LMS) or cervical pedicle screws (CPS) at C7.

SUMMARY OF BACKGROUND DATA: Stopping PCFs at C7 has been controversial because of the risks of adjacent segment disease or nonunions. The two commonly used fixation techniques at the C7 level are LMS and CPS.

METHODS: A retrospective analysis from the Kaiser Permanente Spine Registry identified a cohort of patients with cervical degenerative disc disease who underwent primary PCFs stopping at C7 with either LMS or CPS at C7. Demographic and operative data were extracted from the registry and operative ASD and operative nonunions were adjudicated via chart review. Patients were followed until validated operative ASD or nonunion, membership termination, death, or end of study (03/31/2022). Descriptive statistics and multivariable Cox proportional hazards models were calculated for operative ASDs and operative nonunions.

RESULTS: We found 481 patients with PCFs stopping at C7 with either LMS (n=347) or CPS (n=134) at C7 with average follow-up time of 5.6 (±3.8) years, time to operative ASD of 3.0 (±2.8) years and to operative nonunion of 1.2 (±0.7) years. There were 11 operative ASDs (LMS=8, CPS=3) and 8 operative nonunions (LMS=4, CPS=4). There was no statistical difference between patients stopping at C7 with LMS versus CPS for operative ASDs (HR: 0.68, 95% CI=0.17-2.77, P=0.60) or operative nonunions (HR: 2.09, 95% CI=0.45-8.58, P=0.37).

CONCLUSION: A large cohort of patients with PCFs stopping at C7 with an average follow-up of > 5 years found no statistical difference in reoperation rates for symptomatic ASD (operative ASD) or operative nonunion using either LMS or CPS at C7.

PMID:36763836 | DOI:10.1097/BRS.0000000000004597

Prague Med Rep. 2023;124(1):40-51. doi: 10.14712/23362936.2023.4.

ABSTRACT

To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion &gt; 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being &gt; 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.

PMID:36763830 | DOI:10.14712/23362936.2023.4

Spine (Phila Pa 1976). 2023 Feb 8. doi: 10.1097/BRS.0000000000004593. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective randomized controlled trial.

OBJECTIVE: To clarify whether percutaneous curved vertebroplasty (PCVP) is superior to conventional unipedicular approach vertebroplasty (UVP) in patients with acute osteoporotic vertebral compression fractures (OVCFs).

SUMMARY OF BACKGROUND DATA: Unilateral curved vertebroplasty devices were designed and applied to provide better control of cement placement, which may be superior to traditional UVP for the treatment of acute OVCFs.

METHODS: Patients with single level osteoporotic vertebral compression fractures of less than 6 weeks’ duration and visual analogue scale (VAS) of back pain 5 or more were randomly allocated to undergo PCVP or UVP and were followed up for one year. The primary outcome was overall VAS scores for back pain during 12 months’ follow-up. The secondary outcomes were scores on Oswestry disability index (ODI) at each post-procedure clinic visit. Radiographic (cement distribution) and surgical data (operation time, fluoroscopy frequency and cement volume) were assessed. Complications and adverse events were recorded.

RESULTS: No statistical difference was found between the PCVP and UVP groups with respect to VAS and ODI scores at any follow-up time point. Operative time, fluoroscopy frequency and cement leakage were similar in both groups, while the PCVP techniques had a larger injection of PMMA (5.5±1.4 mL vs. 4.2±1.0 mL) and a greater dispersion pattern of cement (P<0.001). Post hoc observations found that the analgesic effect was positively correlated with the symmetry of bone cement distribution, but not with the surgical method. Two serious adverse events occurred in the vertebroplasty group: one stress ulcer and one allergic reaction.

CONCLUSIONS: While PCVP achieved more symmetrical cement distribution, which appeared to be associated with greater analgesic effect, PCVP did not result in significantly greater pain relief than a UVP in the 12 months following treatment.

PMID:36763817 | DOI:10.1097/BRS.0000000000004593

Prim Care Companion CNS Disord. 2023 Feb 9;25(1):21m03047. doi: 10.4088/PCC.21m03047.

ABSTRACT

Objective: To examine the attitudes among practicing physicians of various specialties toward homosexuality and its association with participants’ religious affiliations in India.

Methods: A cross-sectional descriptive study was conducted among physicians about their attitudes toward homosexuality between December 2018 and January 2019. Participants completed a survey anonymously in hardcopy form or online. The survey was developed based on the Attitude Toward Homosexuality Scale for Indians (AHSI). A higher AHSI score indicates less homonegativity. It was modified by adding demographic details, career status, and personal experience with homosexual individuals.

Results: The study results showed that among 106 respondents, 81 were men with a mean (SD) age of 32.2 (7.3) years. Of the participants, 40 (37.7%) were MBBS graduates with no specialization, while 34 (32.1%) and 32 (30.2%) respondents were from medical and surgical specialties, respectively. The majority of the respondents were Muslim (43.4%), followed by Hindu (35.8%), Christian (10.4%), those not conforming to any religion (5.7%), and other religions (4.7%). The mean ± SD total score on the AHSI was 69.6 ± 17.7, which was higher than the mean neutral score of 60. The AHSI total score was significantly higher among women (P < .001). The total AHSI score was highest among the no religion category followed by Hindus, with the lowest for biblical religions; the difference was statistically significant (P < .001). No significant difference was seen between Muslims and Christians.

Conclusions: This study showed an overall positive attitude among the respondents toward homosexuality; however, those belonging to Abrahamic religions, especially Muslims, had more negative attitudes. The results highlight the need for antistigma campaigns and educational interventions targeting the physician population of India to reduce negative attitudes toward homosexuality and improve their knowledge of this topic.

PMID:36763816 | DOI:10.4088/PCC.21m03047

Lett Appl Microbiol. 2022 Dec 26:ovac077. doi: 10.1093/lambio/ovac077. Online ahead of print.

ABSTRACT

Microbial phytases are potentially excellent candidates for eliminating anti-nutrient i.e. phytic acid, due to hydrolysis of phospho-monoester linkages present in the phytic acid. An average 2.29-fold increase in phytase production was obtained after statistical optimization in solid-state fermentation. Aspergillus oryzae SBS50 phytase was immobilized on a Ca-alginate matrix with an effectiveness of 53%. Immobilized-phytase retained > 50% activity after recycling for five cycles and also displayed more stability in the presence of organic solvents, metal ions, and detergents as compared to free enzyme. Values of Km and Vmax of immobilized phytase were recorded as 0.66 mM and 666.6 nmol/sec, respectively. Immobilized phytase efficiently hydrolyzed the phytate contents in wheat and pearl millet flours, exhibiting > 70% catalytic activity even after three cycles. Phytase supplementation resulted in the improved nutritional quality of these flours. Furthermore, the safety assessment of the treated and untreated samples reveals the absence of any aflatoxin in the phytase produced by the mould. The results revealed the improved stability of phytase after immobilization and as a safe and significant additive for application in the food industry.

PMID:36763800 | DOI:10.1093/lambio/ovac077

Clin Exp Dermatol. 2022 Nov 23:llac086. doi: 10.1093/ced/llac086. Online ahead of print.

ABSTRACT

BACKGROUND: High-risk mucosal human papillomavirus (HR-HPV) seems to play a role in cutaneous squamous cell carcinoma (cSCC), particularly in nail tumours, where genitodigital transmission has been suggested. The role of HR-HPV in nonungual cSCC of the finger needs to be clarified.

AIM: To evaluate the prevalence, clinicopathological characteristics, surrogates and outcomes of HR-HPV in cSCC of the finger.

METHODS: This was an observational bicentric study including patients with an excised in situ or invasive cSCC located on the finger. Differences in HR-HPV and non-HR-HPV tumours were evaluated.

RESULTS: Forty-five patients (45 tumours) were included. HR-HPV was detected in 33% of cases (22% HPV type 16). The mean age was lower in patients with HR-HPV than in those with non-HR-HPV (62·4 vs. 81·1 years, P = 0·001). HR-HPV tumours were smaller (10 mm vs. 15 mm, P = 0·07) and more frequently intraepidermal (60% vs. 20%, P = 0·004). The absence of elastosis (P = 0·030) and inflammation (P = 0·026) and the presence of basaloid morphology (P = 0·003) were surrogates of HR-HPV detection. Mean p16 positivity was 61% in HR-HPV and 36% in non-HR-HPV tumours (P = 0·061). Recurrence after surgery was more common in HR-HPV tumours (58% vs. 34%), although this was not statistically significant. HR-HPV was detected in 27% of the nonungual tumours.

CONCLUSION: HR-HPV-associated cSCC of the finger appears in younger patients, is smaller and is less infiltrative than non-HR-HPV tumours. The presence of a basaloid morphology and the absence of elastosis and inflammation could be used as markers for HR-HPV detection. The high prevalence of HR-HPV in nonungual cSCC suggests its aetiopathogenic role in these tumours.

PMID:36763739 | DOI:10.1093/ced/llac086

PLoS One. 2023 Feb 10;18(2):e0281739. doi: 10.1371/journal.pone.0281739. eCollection 2023.

ABSTRACT

An important question regards the nature of our spatial memories for the paths that we have walked and, in particular, whether such distortions might violate the topological properties of the shape of the paths (i.e., creating an intersection when two paths did not intersect or vice versa). To investigate whether and how this might occur, we tested humans in situations in which they walked simple paths and idiothetic and visual cues either matched or mismatched, with the mismatching cues creating the greatest potential for topological distortions. Participants walked four-segment paths with 90° turns in immersive virtual reality and pointed to their start location when they arrived at the end of the path. In paths with a crossing, when the intersection was not presented, participants pointed to a novel start location suggesting a topological distortion involving non-crossed paths. In paths without a crossing, when a false intersection was presented, participants pointed to a novel start location suggesting a topological distortion involving crossed paths. In paths without crossings and without false intersections, participants showed reduced pointing errors that typically did not involve topological distortions. Distortions more generally, as indicated by pointing errors to the start location, were significantly reduced for walked paths involving primarily idiothetic cues with limited visual cues; conversely, distortions were significantly increased when idiothetic cues were diminished and navigation relied primarily on visual cues. Our findings suggest that our spatial memories for walked paths sometimes involve topological distortions, particularly when resolving the competition between idiothetic and visual cues.

PMID:36763702 | DOI:10.1371/journal.pone.0281739