Nevin Manimala

Neuro Oncol. 2023 Apr 3:noad066. doi: 10.1093/neuonc/noad066. Online ahead of print.

ABSTRACT

BACKGROUND: Prospective data on maintenance therapy with bevacizumab for persons with NF2-related schwannomatosis (NF2-SWN) is lacking. In this prospective multicenter phase 2 study, we evaluated the efficacy, safety, and tolerability of bevacizumab for maintenance therapy in children and adults with NF2-SWN and hearing loss due to vestibular schwannomas (VS).

METHODS: Following induction therapy, participants received bevacizumab 5 mg/kg every 3 weeks for 18 months. Participants were monitored for changes in hearing, tumor size, and quality of life (QOL), and for adverse events. Hearing loss was defined as a statistically significant decline in word recognition score (WRS) or pure tone average compared to study baseline; tumor growth was defined as >20% increase in volume compared to baseline.

RESULTS: Twenty participants with NF2-SWN (median age 23.5 years; range, 12.5-62.5 years) with hearing loss in the target ear (median WRS 70%, range 2-94%) received maintenance bevacizumab. Freedom from hearing loss in the target ear was 95% after 48 weeks, 89% after 72 weeks, and 70% after 98 weeks. Freedom from tumor growth in the target VS was 94% after 48 weeks, 89% after 72 weeks, and 89% after 98 weeks. NF2-related QOL remained stable for 98 weeks whereas tinnitus-related distress decreased. Maintenance bevacizumab was well tolerated, with three participants (15%) discontinuing treatment due to adverse events.

CONCLUSIONS: Maintenance bevacizumab (5 mg/kg every 3 weeks) is associated with high rates of hearing and tumor stability during 18 months of follow-up. No new unexpected adverse events related to bevacizumab were identified in this population.

PMID:37010875 | DOI:10.1093/neuonc/noad066

JAMA Netw Open. 2023 Apr 3;6(4):e236247. doi: 10.1001/jamanetworkopen.2023.6247.

ABSTRACT

IMPORTANCE: The prevalence of electronic nicotine delivery systems (ENDS) use has increased, leading to a concern about their respiratory health outcomes. It is unclear whether ENDS use increases the risk of wheezing, a common symptom of respiratory conditions.

OBJECTIVE: To provide an analysis of the longitudinal association between ENDS and cigarette use and self-reported wheezing among US adults.

DESIGN, SETTING, AND PARTICIPANTS: The US nationally representative Population Assessment of Tobacco and Health (PATH) Study was used. Longitudinal data for adults 18 years or older from wave 1 (2013-2014) to wave 5 (2018-2019) were analyzed. Data were analyzed from August 2021 to January 2023.

MAIN OUTCOMES AND MEASURES: The prevalence of self-reported wheezing (waves 2-5) was estimated for 6 strata of tobacco product use (never cigarette and noncurrent ENDS use, never cigarette and current ENDS use, current cigarette and noncurrent ENDS use, current cigarette and current ENDS use, former cigarette and noncurrent ENDS use, and former cigarette and current ENDS use). A generalized estimating equations framework evaluated the association between cigarette and ENDS use and self-reported wheezing at the subsequent wave. An interaction term between cigarette and ENDS use was added to estimate the association between joint cigarette and ENDS use categories and the association of ENDS within strata of cigarette use.

RESULTS: The analytical sample consisted of 17 075 US adults with a mean (SD) age of 45.4 (17) years, of whom 8922 (51%) were female and 10 242 (66%) were Non-Hispanic White. When compared with never cigarette and noncurrent ENDS use, the greatest association in reporting wheezing was for current cigarette and current ENDS use (adjusted odds ratio [AOR], 3.26; 95% CI, 2.82-3.77), which was similar to current cigarette and noncurrent ENDS use (AOR, 3.20; 95% CI, 2.91-3.51) and substantially greater than former cigarette and current ENDS use (AOR, 1.94; 95% CI, 1.57-2.41). Associations were small and not statistically significant for the odds of self-reported wheezing among never cigarette and current ENDS use when compared with never cigarette and noncurrent ENDS use (AOR, 1.20; 95% CI, 0.83-1.72), and for odds of wheezing and current cigarette and current ENDS use when compared with current cigarette and noncurrent ENDS use (AOR, 1.02; 95% CI, 0.91-1.15).

CONCLUSIONS AND RELEVANCE: In this cohort study, exclusive ENDS use was not associated with an increase in the risk of self-reported wheezing. However, a small increase in risk between ENDS use and wheezing was reported by individuals who use cigarettes. This study adds to the literature about the potential health effects associated with ENDS use.

PMID:37010872 | DOI:10.1001/jamanetworkopen.2023.6247

JAMA Netw Open. 2023 Apr 3;6(4):e236331. doi: 10.1001/jamanetworkopen.2023.6331.

ABSTRACT

IMPORTANCE: Family meals are a formative learning environment that shapes children’s food choices and preferences. As such, they are an ideal setting for efforts to improve children’s nutritional health.

OBJECTIVE: To examine the effect of extending the duration of family meals on the fruit and vegetable intake in children.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial used a within-dyad manipulation design and was conducted from November 8, 2016, to May 5, 2017, in a family meal laboratory in Berlin, Germany. Included in the trial were children aged 6 to 11 years who did not follow a special diet or have food allergies and adult parents who served as the nutritional gatekeeper in the household (ie, the family member responsible for at least half of the food planning and preparation). All participants underwent 2 conditions: control, defined as regular family mealtime duration, and intervention, defined as 50% longer mealtime duration (10 minutes longer on average). Participants were randomized to the condition they would complete first. Statistical analyses of the full sample were conducted between June 2 and October 30, 2022.

INTERVENTIONS: Participants had 2 free evening meals under different conditions. In the control or regular condition, each dyad ate in the same amount of time as their reported regular mealtime duration. In the intervention or longer condition, each dyad had 50% more time to eat than their reported regular mealtime duration.

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of pieces of fruits and vegetables eaten by the child during a meal.

RESULTS: A total of 50 parent-child dyads participated in the trial. Parents had a mean (range) age of 43 (28-55 years) years and were predominantly mothers (36 [72%]). Children had a mean (range) age of 8 (6-11) years and included an equal number of girls and boys (25 [50%]). Children ate significantly more pieces of fruits (t49 = 2.36, P = .01; mean difference [MD], 3.32 [95% CI, 0.96 to ∞]; Cohen d = 0.33) and vegetables (t49 = 3.66, P < .001; MD, 4.05 [95% CI, 2.19 to ∞]; Cohen d = 0.52) in the longer condition than in the regular mealtime duration condition. Consumption of bread and cold cuts did not significantly differ between conditions. The children’s eating rate (bites per minute over the regular mealtime duration) was significantly lower in the longer than in the regular condition (t49 = -7.60, P < .001; MD, -0.72 [95% CI, -0.56 to ∞]; Cohen d = 1.08). Children reported significantly higher satiety after the longer condition (V = 36.5, P < .001).

CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial suggest that the simple, low-threshold intervention of increasing family mealtime duration by approximately 10 minutes can improve the quality of children’s diet and eating behavior. The findings underscore the potential for such an intervention to improve public health.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03127579.

PMID:37010871 | DOI:10.1001/jamanetworkopen.2023.6331

JAMA Netw Open. 2023 Apr 3;6(4):e236438. doi: 10.1001/jamanetworkopen.2023.6438.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic substantially disrupted routine health care and exacerbated existing barriers to health care access. Although postpartum women frequently experience pain that interferes with activities of daily living, which is often successfully treated with prescription opioid analgesics, they are also at high risk for opioid misuse.

OBJECTIVE: To compare postpartum opioid prescription fills after the onset of the COVID-19 pandemic in March 2020 with fills before the pandemic.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of 460 371 privately insured postpartum women who delivered a singleton live newborn between July 1, 2018, and December 31, 2020, postpartum opioid fills before March 1, 2020, were compared with fills after March 1, 2020. Statistical analysis was performed from December 1, 2021, to September 15, 2022.

EXPOSURE: COVID-19 pandemic onset in March 2020.

MAIN OUTCOMES AND MEASURES: The main outcome was postpartum opioid fills, defined as patient fills of opioid prescriptions during the 6 months after birth. Opioid prescriptions were explored in terms of 5 measures: mean number of fills per person, mean filled morphine milligram equivalents (MMEs) per day, mean days supplied, percentage of patients filling a prescription for a schedule II opioid, and percentage of patients filling a prescription for a schedule III or higher opioid.

RESULTS: Among 460 371 postpartum women (mean [SD] age at delivery, 29.0 [10.8] years), those who gave birth to a single, live newborn after March 2020 were 2.8 percentage points more likely to fill an opioid prescription than expected based on the preexisting trend (forecasted, 35.0% [95% CI, 34.0%-35.9%]; actual, 37.8% [95% CI, 36.8%-38.7%]). The COVID-19 period was also associated with an increase in MMEs per day (forecasted mean [SD], 34.1 [2.0] [95% CI, 33.6-34.7]; actual mean [SD], 35.8 [1.8] [95% CI, 35.3-36.3]), number of opioid fills per patient (forecasted, 0.49 [95% CI, 0.48-0.51]; actual, 0.54 [95% CI, 0.51-0.55]), and percentage of patients filling a schedule II opioid prescription (forecasted, 28.7% [95% CI, 27.9%-29.6%]; actual, 31.5% [95% CI, 30.6%-32.3%]). There was no significant association with days’ suppy of opioids per prescription or percentage of patients filling a prescription for a schedule III or higher opioid. Results stratified by delivery modality showed that the observed increases were larger for patients who delivered by cesarean birth than those delivering vaginally.

CONCLUSIONS AND RELEVANCE: This cross-sectional study suggests that the onset of the COVID-19 pandemic was associated with significant increases in postpartum opioid fills. Increases in opioid prescriptions may be associated with increased risk of opioid misuse, opioid use disorder, and opioid-related overdose among postpartum women.

PMID:37010867 | DOI:10.1001/jamanetworkopen.2023.6438

JAMA. 2023 Apr 3. doi: 10.1001/jama.2023.4590. Online ahead of print.

NO ABSTRACT

PMID:37010865 | DOI:10.1001/jama.2023.4590

Musculoskeletal Care. 2023 Apr 3. doi: 10.1002/msc.1763. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to determine the prevalence, the main features and the potential risk factors of LBP in pregnant women.

METHODS: This cross-sectional study included 173 pregnant women in the third trimester. Non-inclusion criteria were severe mental disability and known previous history of musculoskeletal diseases. The participants were categorised into two groups: women with pregnancy-related LBP and pain-free women. Demographic, socio-professional, clinical and obstetrical data were compared between the two groups using the appropriate statistical tests.

RESULTS: The mean age was 32.2 ± 5.4 years [17-45]. Among them, 108 (62.4%) reported one or more episodes of LBP during at least 7 days, mostly in the third semester (n = 71). The presence of LBP was significantly associated with history of LBP in previous pregnancies and jobs requiring prolonged standing. Active jobs and the presence of gestational complications were significantly more common in pain-free women. In the multivariate analysis, LBP was independently predicted by the history of LBP in previous pregnancies and the absence of gestational complications.

CONCLUSIONS: The association of LBP with gestational complications as a protective factor has not yet been reported in previous studies. These complications are a common cause of hospitalisation, which represents a period of relative rest during pregnancy. Our results revealed that history of LBP in previous pregnancies, sedentary lifestyle prior to pregnancy and prolonged standing are the main risk factors of LBP. In contrast, rest and avoidance of physical overstrain during pregnancy may be protective factors.

PMID:37010863 | DOI:10.1002/msc.1763

Cancer Control. 2023 Jan-Dec;30:10732748231167958. doi: 10.1177/10732748231167958.

ABSTRACT

OBJECTIVE: We tested the performance of general machine learning and joint machine learning algorithms in the classification of bone metastasis, in patients with lung adenocarcinoma.

METHODS: We used R version 3.5.3 for statistical analysis of the general information, and Python to construct machine learning models.

RESULTS: We first used the average classifiers of the 4 machine learning algorithms to rank the features and the results showed that race, sex, whether they had surgery and marriage were the first 4 factors affecting bone metastasis. Machine learning results in the training group: for area under the curve (AUC), except for RF and LR, the AUC values of all machine learning classifiers were greater than .8, but the joint algorithm did not improve the AUC for any single machine learning algorithm. Among the results related to accuracy and precision, the accuracy of other machine learning classifiers except the RF algorithm was higher than 70%, and only the precision of the LGBM algorithm was higher than 70%. Machine learning results in the test group: Similarly, for areas under the curve (AUC), except RF and LR, the AUC values for all machine learning classifiers were greater than .8, but the joint algorithm did not improve the AUC value for any single machine learning algorithm. For accuracy, except for the RF algorithm, the accuracy of other machine learning classifiers was higher than 70%. The highest precision for the LGBM algorithm was .675.

CONCLUSION: The results of this concept verification study show that machine learning algorithm classifiers can distinguish the bone metastasis of patients with lung cancer. This will provide a new research idea for the future use of non-invasive technology to identify bone metastasis in lungcancer. However, more prospective multicenter cohort studies are needed.

PMID:37010850 | DOI:10.1177/10732748231167958

Neurogastroenterol Motil. 2023 Apr 3:e14582. doi: 10.1111/nmo.14582. Online ahead of print.

ABSTRACT

BACKGROUND: Data for Spain from the Rome Foundation Global Epidemiology Study on the disorders of gut-brain interaction (DGBI) were used to assess the national and regional prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in our country.

METHODS: Data were collected through an anonymous, nationwide, and secure Internet survey with multiple built-in quality-assurance techniques that included the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire.

KEY RESULTS: The survey was completed by 2072 adult Spanish participants (50.2% female) with a mean age of 45.67 ± 15.44 years with a good representative national distribution. 43.6% (41.5%-45.8%) met diagnostic criteria for at least one DGBI, with 8.2% for any esophageal disorder, 12.1% for any gastroduodenal disorder, 30.1% for any bowel disorder, and 11.5% for any anorectal disorder. Functional constipation was the most prevalent DGBI in Spain (12.8%). We found that proctalgia fugax (9.3%), unspecified bowel disorders (10.8%), and functional dysphagia (5.6%) showed unexplained high rates in our country. DGBI rates were higher for women. Having any DGBI was negatively associated with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and associated with increased healthcare utilization.

CONCLUSIONS & INFERENCES: We provide the first comprehensive data on the prevalence and burden of all DGBI in Spain using the Rome IV criteria. The enormous burden of DGBI in Spain highlights the need for specialized training and future research.

PMID:37010843 | DOI:10.1111/nmo.14582

JAMA Pediatr. 2023 Apr 3. doi: 10.1001/jamapediatrics.2023.0346. Online ahead of print.

ABSTRACT

IMPORTANCE: Lithium is a naturally occurring and trace element that has mood-stabilizing effects. Maternal therapeutic use of lithium has been associated with adverse birth outcomes. In animal models, lithium modulates Wnt/β-catenin signaling that is important for neurodevelopment. It is unknown whether exposure to lithium in drinking water affects brain health in early life.

OBJECTIVE: To evaluate whether autism spectrum disorder (ASD) in offspring is associated with maternal exposure to lithium in drinking water during pregnancy.

DESIGN, SETTING AND PARTICIPANTS: This nationwide population-based case-control study in Denmark identified 8842 children diagnosed with ASD born from 2000 through 2013 and 43 864 control participants matched by birth year and sex from the Danish Medical Birth Registry. These data were analyzed from March 2021 through November 2022.

EXPOSURES: Geocoded maternal residential addresses during pregnancy were linked to lithium level (range, 0.6 to 30.7 μg/L) in drinking water estimated using kriging interpolation based on 151 waterworks measurements of lithium across all regions in Denmark.

MAIN OUTCOMES AND MEASURES: ASD diagnoses were ascertained using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes recorded in the Danish Psychiatric Central Register. The study team estimated odds ratios (ORs) and 95% CIs for ASD according to estimated geocoded maternal exposure to natural source of lithium in drinking water as a continuous (per IQR) or a categorical (quartile) variable, adjusting for sociodemographic factors and ambient air pollutants levels. The study team also conducted stratified analyses by birth years, child’s sex, and urbanicity.

RESULTS: A total of 8842 participants with ASD (male, 7009 [79.3%]) and 43 864 control participants (male, 34 749 [79.2%]) were studied. Every IQR increase in estimated geocoded maternal exposure to natural source of lithium in drinking water was associated with higher odds for ASD in offspring (OR, 1.23; 95% CI, 1.17-1.29). Elevated odds among offspring for ASD were estimated starting from the second quartile (7.36 to 12.67 μg/L) of estimated maternal exposure to drinking water with lithium and the OR for the highest quartile (more than 16.78 μg/L) compared with the reference group (less than 7.39 μg/L) was 1.46 (95% CI, 1.35-1.59). The associations were unchanged when adjusting for air pollution exposures and no differences were apparent in stratified analyses.

CONCLUSIONS AND RELEVANCE: Estimated maternal prenatal exposure to lithium from naturally occurring drinking water sources in Denmark was associated with an increased ASD risk in the offspring. This study suggests that naturally occurring lithium in drinking water may be a novel environmental risk factor for ASD development that requires further scrutiny.

PMID:37010840 | DOI:10.1001/jamapediatrics.2023.0346

Infection. 2023 Apr 3. doi: 10.1007/s15010-023-02015-w. Online ahead of print.

NO ABSTRACT

PMID:37010806 | DOI:10.1007/s15010-023-02015-w