Nevin Manimala

Eur J Breast Health. 2022 Apr 1;18(2):127-133. doi: 10.4274/ejbh.galenos.2022.2021-12-1. eCollection 2022 Apr.

ABSTRACT

OBJECTIVE: Oncoplastic reconstruction (OR) enables widening of the indications for breast conserving therapy (BCT) and is redefining the limits of breast conservation. We examined the outcome and satisfaction of patients undergoing OR after radical lumpectomy (excision of more than 25% of the breast volume) and compared it to the outcome of women undergoing OR after standard lumpectomy.

MATERIALS AND METHODS: A retrospective, cohort study, including all patients undergoing OR after BCT between 2009 and 2018, was conducted. The ratio of volume of excision to breast volume was calculated using imaging studies. The study group included women that had more than 25% of their breast volume removed. The remainder formed the control group. Demographic characteristics, oncological treatment, and operation properties were collected. We compared post-operative complications, margin status and need for further surgery, as well as patient satisfaction, evaluated using the BREAST-Q Questionnaire.

RESULTS: One hundred and fifty women were included, of whom 24 (16%) comprised the study group with a mean breast volume reduction of 39%, while the remainder (mean volume reduction 8%) served as controls. Patient, tumor characteristics and treatment were comparable. There was a non-significant higher proportion of women in the radical group that underwent a second operation due to complications or positive margins [4/24 (16.7%) vs. 14/126 (11%), p = 0.4). Physical well-being was similar but satisfaction with breasts and with outcome was slightly lower for the study group. These differences did not reach statistical significance.

CONCLUSION: Surgical outcome and patient satisfaction in women undergoing very extensive breast resections with OR are comparable to standard resections.

PMID:35445184 | PMC:PMC8987856 | DOI:10.4274/ejbh.galenos.2022.2021-12-1

Biomed Res Int. 2022 Apr 11;2022:5143383. doi: 10.1155/2022/5143383. eCollection 2022.

ABSTRACT

BACKGROUND: In this study, we introduced a novel surgical strategy to protect vagal nerve branches during radical thoracoscopic surgery in right lung cancer and explored the effects of vagal nerve branch preservation.

METHODS: We retrospectively studied 53 patients with right-sided lung cancer with clinically staged T1N0M0 between 2019 and 2020. All 53 patients were treated with total thoracoscopic lobectomy and mediastinal lymph node dissection in the same number of lymph node stations. Of these, 22 patients adopted a vagus nerve branch protection strategy during lymph node dissection. Another 31 patients were treated with traditional lymph node dissection as the control group.

RESULTS: The characteristics of the patients were similar between the two groups. The operation time and intraoperative bleeding in the protection group were longer than those in the control group. However, the protection group had a lower average postoperative pain score and average postoperative hospital stay. The above difference was not statistically significant. Three cases of arrhythmia occurred in the protection group, including 1 case of tachycardia and 2 cases of atrial fibrillation. In the control group, 13 cases of arrhythmia occurred after the operation, including 8 cases of tachycardia and 5 cases of atrial fibrillation. We also tracked changes in the patients’ heart rates throughout the treatment process (excluding patients with arrhythmias). An increased heart rate was observed postoperatively in both groups, but the increase of heart rate of the protection group was smaller than that of the control group; however, the difference was not statistically significant.

CONCLUSIONS: A vagus nerve branch preservation-based approach to radical surgery is a safe and feasible strategy for right lung cancer treatment, which could significantly reduce the risk of postoperative arrhythmia in patients and may also have a potential role in reducing the length of hospital stay and maintaining heart rate stability in the postoperative period.

PMID:35445140 | PMC:PMC9015860 | DOI:10.1155/2022/5143383

Arch Clin Neuropsychol. 2022 Apr 19:acac018. doi: 10.1093/arclin/acac018. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence suggests that select hippocampal subfields are implicated in the initial stages of Alzheimer’s disease (AD) and are selectively involved in objective memory. Less is known whether subfields are associated with informant-reported memory difficulties of individuals with a diagnosis of mild cognitive impairment (MCI).

METHOD: Data from 56 participants with a diagnosis of amnestic MCI were included in the present study. To test whether FreeSurfer derived hippocampal subfields (CA1-4, subiculum, presubiculum, and dentate gyrus) were associated with objective (learning and delayed recall) and informant-reports of memory difficulties, we used multiple linear regression analysis. Subfields were adjusted for total intracranial volume, and age, sex, and years of education were included as covariates in all models.

RESULTS: Larger presubiculum, subiculum, and CA4/dentate gyrus volumes were associated with higher delayed recall scores, and larger subiculum and CA4/dentate gyrus volumes were associated with fewer informant-reports of memory difficulties. There were no statistically significant associations between subfields and learning scores.

DISCUSSION: Findings from the present study support the idea that difficulties with memory-dependent everyday tasks in older adults with MCI may signal a neurodegenerative process while increasing understanding of subfields correlates of these memory-specific functional difficulties. Continued investigations into identifying patterns of subfield atrophy in AD may aid early identification of those at higher risk of dementia conversion while advancing precision medicine.

PMID:35443280 | DOI:10.1093/arclin/acac018

Ann Plast Surg. 2022 May 1;88(5):533-537. doi: 10.1097/SAP.0000000000003009.

ABSTRACT

BACKGROUND: Neuromas, neuralgia, and phantom limb pain commonly occur after lower-extremity amputations; however, incidence of these issues is poorly reported and understood. Present literature is limited to small cohort studies of amputees, and the reported incidence of chronic pain after amputation ranges as widely as 0% to 80%. We sought to objectively investigate the incidence of postamputation pain and nerve-related complications after lower-extremity amputation.

METHODS: Patients who underwent lower-extremity amputation between 2007 and 2017 were identified using a national insurance-based claims database. Incidence of reporting of postoperative neuroma, neuralgia, and phantom limb pain were identified. Patient demographics and comorbidities were assessed. Average costs of treatment were determined in the year after lower-extremity amputation. Logistic regression analyses and resulting odds ratios were calculated to determine statistically significant increases in incidence of postamputation nerve-related pain complications in the setting of demographic factors and comorbidities.

RESULTS: There were 29,507 lower amputations identified. Postoperative neuralgia occurred in 4.4% of all amputations, neuromas in 0.4%, and phantom limb pain in 10.9%. Nerve-related pain complications were most common in through knee amputations (20.3%) and below knee amputations (16.7%). Male sex, Charlson Comorbidity Index > 3, diabetes mellitus, diabetic neuropathy, diabetic angiopathy, diabetic retinopathy, obesity, peripheral vascular disease, and tobacco abuse were associated with statistically significant increases in incidence of 1-year nerve-related pain or phantom limb pain.

CONCLUSIONS: Given the incidence of these complications after operative extremity amputations and associated increased treatment costs, future research regarding their pathophysiology, treatment, and prevention would be beneficial to both patients and providers.

PMID:35443269 | DOI:10.1097/SAP.0000000000003009

Ann Plast Surg. 2022 May 1;88(5):490-495. doi: 10.1097/SAP.0000000000003146.

ABSTRACT

BACKGROUND: After breast surgery with or without immediate reconstruction, chronic pain can be a major problem for patients. However, few studies have examined the details of the sites of long-lasting postoperative pain. In this study, we specified the postoperative pain location after breast surgery, including reconstruction, to find ways to improve surgical procedures or provide effective pain relief.

METHODS: The subjects were 205 Japanese women undergoing mastectomy or breast reconstruction with a tissue expander (TE)/implant or a deep inferior epigastric perforator (DIEP) flap. Patients were asked whether they had pain in different parts of the body at 1 year after surgery. Differences were assessed by cross-tabulation and χ2 statistics.

RESULTS: Surveys were completed by 157 subjects. Deep inferior epigastric perforator flap cases had significantly more pain and TE/Imp cases had significantly less pain in the medial breast, upper breast, breast upper medial quadrant, and abdomen (P = 0.006, P = 0.006, P < 0.001, P < 0.001, respectively). In the neck area, pain in TE/Imp cases was significantly worse than that in all other patients (P = 0.025). There was no significant difference in chronic pain in any other body regions among the mastectomy only, TE/Imp, and DIEP flap groups.

CONCLUSIONS: The results of the present study revealed that the localization of prolonged postoperative pain after breast surgery differs depending on the surgical procedure. In DIEP flap reconstruction, there was a marked tendency for pain in the inner and upper chest and in the abdomen, whereas TE/IMP surgery resulted in pain around the neck of the affected side. These findings may help improve surgical methods and establish effective pain relief that focuses on the identified pain areas.

PMID:35443265 | DOI:10.1097/SAP.0000000000003146

Ann Plast Surg. 2022 May 1;88(5):480-484. doi: 10.1097/SAP.0000000000003099. Epub 2022 Feb 18.

ABSTRACT

INTRODUCTION: Nasal osteotomy is a powerful cornerstone step in almost all rhinoplasty procedures and is a major cause of postoperative periorbital ecchymosis and edema after rhinoplasty. Different accesses for osteotomy have been described, the most popular of which is the external perforating and the internal continuous methods. These accesses are blind maneuvers and have some drawbacks such as possible visible scar formation in the percutaneous access or high rate of mucosal tear in the endonasal access. Open sky access osteotomy after wide subperiosteal dissection had been described to overcome those disadvantages. Early postoperative sequelae have not been assessed in the literature after using this access. In the present study, we aim to assess early postoperative sequelae after using this technique in comparison with percutaneous perforating osteotomy.

MATERIALS AND METHODS: The study was conducted between November 2017 and January 2021. Forty patients were randomly assigned into 2 equal groups. Group A was subjected to lateral osteotomy by percutaneous perforating method, whereas group B underwent lateral osteotomy by the open sky access technique using a 2-mm curved osteotome. Early postoperative periorbital sequelae were assessed on the second and seventh postoperative days, using the grading system suggested by Kara et al (Plast Reconstr Surg. 1999;104:2213-2218). Mucosal tear was assessed on the second postoperative day using nasal endoscopy after removal of nasal packs.

RESULTS: There was a statistically nonsignificant difference between the studied groups regarding ecchymosis and edema occurring on the second or seventh days. Meanwhile, mucosal tear was significantly less in the open sky access osteotomy group.

CONCLUSIONS: Open sky access osteotomy is a safe method for lateral nasal osteotomy with direct visualization of the surgical field. It does not require a skin incision that could lead to a scar formation. It produces less mucosal tear than percutaneous perforating osteotomy. No statistically significant difference is found between both techniques regarding postoperative periorbital ecchymosis and edema on the second and seventh postoperative days.

PMID:35443264 | DOI:10.1097/SAP.0000000000003099

Am J Nephrol. 2022 Apr 20:1-9. doi: 10.1159/000524110. Online ahead of print.

ABSTRACT

INTRODUCTION: The patient-to-nurse ratio is highly variable among dialysis facilities. However, there is little known about the association between nurse caseload and hemodialysis (HD) patient outcomes. We evaluated the association between patient-to-nurse ratio and mortality in the Korean patients undergoing HD.

METHODS: We used HD quality assessment data and National Health Insurance Service claim data from the year of 2013 for collecting demographic and clinical data. Altogether, 21,817 patients who participated in the HD quality assessment in 2013 were included in the study. Nurse caseload was defined as the number of HD sessions performed by a nurse per working day. The patients were divided into two groups according to the nurse caseload as follows: low nurse caseload group (≤6.0) and high nurse caseload group (>6.0). We analyzed mortality risk based on nurse caseload using the Cox proportional hazard model.

RESULTS: The mean age was 59.1 years, and males accounted for 58.5%. The mean hemoglobin was 10.6 g/dL and albumin was 3.99 g/dL. At the mean follow-up duration of 51.7 (20.6) months, the ratio between low and high groups was 69.6% (15,184 patients) versus 30.4% (6,633 patients). The patients in the high nurse caseload group were older and showed lower levels of hemoglobin, albumin, calcium, and iron saturation and higher levels of phosphorus than those in the low nurse caseload group. A high nurse caseload was associated with a lower survival rate. In the adjusted Cox analysis, a high nurse caseload was an independent risk factor for all-cause mortality (hazard ratio 1.08; 95% confidence interval, 1.02-1.14; p = 0.01).

CONCLUSION: High nurse caseload was associated with an increased mortality risk among the patients undergoing HD. Further prospective studies are needed to determine whether a caseload of nursing staff can improve the prognosis of HD patients.

PMID:35443245 | DOI:10.1159/000524110

Int J Pediatr Otorhinolaryngol. 2022 Apr 15;157:111136. doi: 10.1016/j.ijporl.2022.111136. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate which components of pediatric otolaryngology fellowship applications are more closely predictive of future academic productivity in applicants who go on to complete their fellowship training.

METHODS: Applications to our institution’s ACGME accredited pediatric otolaryngology fellowship program through the SF Match program for the years 2011-2016 were reviewed. Applicant files on record were utilized to extract independent variables including sex, mean USMLE score, residency program Doximity ranking, military experience, number of national honors/awards, AOA status, total number of publications listed on application, number of first author publications listed on application, and AAOHNS Committee involvement. Academic productivity was determined by number of PubMed indexed publications per year, practice setting, and H-index (Scopus). Statistical analysis consisted of multivariate and univariate regression models, with p < 0.05 being considered statistically significant.

RESULTS: Multivariate regression showed that USMLE Step 1 and 2 mean score and number of publications listed on application exhibited statistically significant correlations with a higher number of future post fellowship publications per year. Residency program Doximity rank, applicant number of awards and honors, AOA status, and number of first author publications were not predictive of future academic productivity. No statistically significant associations were found between any variables and the faculty position outcome variable.

CONCLUSIONS: Quantifiable criteria in pediatric otolaryngology fellowship applications, such as number of listed publications and mean USMLE scores are strongly correlated with future academic productivity metrics.

PMID:35443230 | DOI:10.1016/j.ijporl.2022.111136

Photodiagnosis Photodyn Ther. 2022 Apr 17:102873. doi: 10.1016/j.pdpdt.2022.102873. Online ahead of print.

ABSTRACT

INTRODUCTION: Shockwave enhanced emission photoacoustic streaming (SWEEPS) of Er: YAG laser has been proposed to improve the disinfecting efficacy of endodontic treatments. The purpose of this in vitro study was to compare the effects of different concentrations of sodium hypochlorite (NaOCl) combined with SWEEPS root canal irrigation on the removal of Enterococcus faecalis (E.faecalis) in infected bovine root canals.

MATERIALS AND METHODS: Forty-eight bovine root canals infected with E.faecalis were randomly divided into six groups. The root canals were irrigated by normal saline (NS) in combination with conventional needle irrigation (CI) , NS and different concentrations of NaOCl (0.5%, 1.0%, 2.0%, and 5.25%) in combination with SWEEPS. Then, the remaining live microbes from all specimens before and after root canal irrigation were collected and recovered via plate counting of the colony-forming unit (CFU). The CFU data were statistically analyzed by the Kruskal-Wallis H test.

RESULTS: After root canal irrigation, the viable count in each group was significantly reduced (P < 0.05). The bacterial reduction in NS+CI and NS+SWEEPS groups was significantly lower than that in other groups (P < 0.05), and there was no significant difference among the other groups, or between these two groups (P > 0.05).

CONCLUSIONS: This study showed that SWEEPS used for root canal irrigation can enhance the effect of low-concentration NaOCl while ensuring the antimicrobial effect.

PMID:35443216 | DOI:10.1016/j.pdpdt.2022.102873

Exp Eye Res. 2022 Apr 17:109080. doi: 10.1016/j.exer.2022.109080. Online ahead of print.

ABSTRACT

Conjunctival swabs (CS) are the major source of sampling for ocular microbiome studies, however collecting CS from the diseased eyes is difficult and painful. In this study, as an alternative to CS, a less invasive approach of tear collection was used to establish the bacterial microbiome in healthy eyes. Tear bacterial microbiome was generated from the DNA of tears (n = 24; male = 16 and female = 8) of healthy volunteers aged from 20 to 52 years. Sequencing of V3-V4 region of 16S rRNA gene was performed on the Illumina platform. Reads were processed in QIIME to assign the taxa. Statistical analysis of the tear microbiome was done in R to assess the alphadiversity and betadiversity indices. Tear microbiome was generated in all the 24 tear samples. Eight out of the top 10 predominant bacterial genera remained same in both tear and CS microbiomes, which include genera such as Corynebacterium, Staphylococcus, Streptococcus, Mycobacterium, Escherichia-Shigella, Lactobacillus, Bacillus and Acinetobacter. The similarity network analysis indicates that 144 out of 145 genera of tear cohort matched with conjunctival swabs. However, tear and CS microbiomes differed in the abundance of the predominant bacterial genera. The bacterial microbiome of tears in adults appears to be stable and is comparable with that of CS microbiome.

PMID:35443208 | DOI:10.1016/j.exer.2022.109080