Nevin Manimala

Urologia. 2022 Apr 21:3915603221093719. doi: 10.1177/03915603221093719. Online ahead of print.

ABSTRACT

PURPOSE: If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment.

MATERIALS AND METHODS: Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48).

RESULTS: There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05).

CONCLUSION: Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.

PMID:35445621 | DOI:10.1177/03915603221093719

Ann Palliat Med. 2022 Apr 13:apm-21-3465. doi: 10.21037/apm-21-3465. Online ahead of print.

ABSTRACT

BACKGROUND: There is uncertainty of the effect of immunosuppression, including corticosteroids, before COVID-19 infection on COVID-19 outcomes. The aim of this study was to investigate the relationship between prehospitalization immunosuppressants use (exposure) and COVID-19 patient outcomes.

METHODS: We conducted a population-based retrospective cohort study using a nationwide healthcare claims database of South Korea as of May 15, 2020. Confirmed COVID-19 infection in hospitalized individuals aged 40 years or older were included for analysis. We defined exposure variable by using inpatient and outpatient prescription records of immunosuppressants from the database. Our primary endpoint was a composite endpoint of all-cause death, intensive care unit (ICU) admission, and mechanical ventilation use. Inverse probability of treatment weighting (IPTW)-adjusted logistic regression analyses were used, to estimate odds ratio (OR) and 95% confidence intervals (CI), comparing immunosuppressants users and nonusers.

RESULTS: We identified 4,349 patients, for which 1,356 were immunosuppressants users and 2,993 were non-users. Patients who used immunosuppressants were at increased odds of the primary endpoint of all-cause death, ICU admission and mechanical ventilation use (IPTW OR =1.32; 95% CI: 1.06-1.63), driven by higher odds of all-cause mortality (IPTW OR =1.63; 95% CI: 1.21-2.26). Patients who used corticosteroids (n=1,340) were at increased odds of the primary endpoint (IPTW OR =1.33; 95% CI: 1.07-1.64).

CONCLUSIONS: Immunosuppressant use was associated with worse outcomes among COVID-19 patients. These findings support the latest guidelines from the CDC that people on immunosuppressants are at high risk of severe COVID-19 and that immunocompromised people may benefit from booster COVID-19 vaccinations.

PMID:35445604 | DOI:10.21037/apm-21-3465

J Biomed Opt. 2022 Apr;27(8). doi: 10.1117/1.JBO.27.8.083018.

ABSTRACT

SIGNIFICANCE: Code verification is an unavoidable step prior to using a Monte Carlo (MC) code. Indeed, in biomedical optics, a widespread verification procedure for MC codes is still missing. Analytical benchmarks that can be easily used for the verification of different MC routines offer an important resource.

AIM: We aim to provide a two-step verification procedure for MC codes enabling the two main tasks of an MC simulator: (1) the generation of photons’ trajectories and (2) the intersections of trajectories with boundaries separating the regions with different optical properties. The proposed method is purely based on elementary analytical benchmarks, therefore, the correctness of an MC code can be assessed with a one-sample t-test.

APPROACH: The two-step verification is based on the following two analytical benchmarks: (1) the exact analytical formulas for the statistical moments of the spatial coordinates where the scattering events occur in an infinite medium and (2) the exact invariant solutions of the radiative transfer equation for radiance, fluence rate, and mean path length in media subjected to a Lambertian illumination.

RESULTS: We carried out a wide set of comparisons between MC results and the two analytical benchmarks for a wide range of optical properties (from non-scattering to highly scattering media, with different types of scattering functions) in an infinite non-absorbing medium (step 1) and in a non-absorbing slab (step 2). The deviations between MC results and exact analytical values are usually within two standard errors (i.e., t-tests not rejected at a 5% level of significance). The comparisons show that the accuracy of the verification increases with the number of simulated trajectories so that, in principle, an arbitrary accuracy can be obtained.

CONCLUSIONS: Given the simplicity of the verification method proposed, we envision that it can be widely used in the field of biomedical optics.

PMID:35445592 | DOI:10.1117/1.JBO.27.8.083018

Orthop Surg. 2022 Apr 21. doi: 10.1111/os.13283. Online ahead of print.

ABSTRACT

OBJECTIVE: In this study we concerned on the morphological characteristics of the greater tuberosity of humerus and proposed the double-circle radius ratio as a new predictor for the diagnosis of rotator cuff tears.

METHODS: This was a retrospective study and patients who visited our hospital and were diagnosed with or without rotator cuff tears via magnetic resonance imaging from January 2018 to July 2021 were enrolled and classified into two groups respectively. In a standard anteroposterior view, the radius of the best-fit circle of humeral head and the radius of the concentric circle passing through the most lateral edge of the greater tuberosity were measured in each shoulder. The ratio of these two radiuses was named as the double-circle radius ratio. Angular parameters including the greater tuberosity angle and the critical shoulder angle were also measured in the anteroposterior view. Independent samples t tests and chi-square tests were used to find significant differences between groups. Significant associations between those measured variables and demographic characteristics were analyzed with simple linear regression analysis. Receiver operating characteristic curves were pictured to determine applied cutoff values by using Youden index. Multivariable-adjusted analysis for the occurrence of rotator cuff tears was carried out by using multiple logistic regression analysis. For all tests a p value of <0.05 was considered statistically significant.

RESULTS: One hundred and twelve shoulders with rotator cuff tears and 42 shoulders without rotator cuff tears were included. The mean value of the double-circle radius ratio was significantly larger in shoulders with rotator cuff tears (1.42 ± 0.09 vs. 1.30 ± 0.07, P = 0.000). With simple linear regression analysis, the radiuses of the humeral head and the greater tuberosity were significantly associated with heights and weights. In receiver operating characteristic curves, the largest area was found under the curve of the double-circle radius ratio as 0.846 (95% CI, 0.781-0.911; P = 0.000) with an applied cutoff value as 1.38 (sensitivity, 70.5%; specificity, 88.1%). Multivariable-adjusted analysis showed that a value of the double-circle radius ratio >1.38 resulted in 11.252-fold odds of developing rotator cuff tears (95% CI, 3.388-37.368; P = 0.000).

CONCLUSION: The double-circle radius ratio is significantly larger in patients with rotator cuff tears and could be regarded as an eligible predictor for rotator cuff tears.

PMID:35445590 | DOI:10.1111/os.13283

Orthop Surg. 2022 Apr 21. doi: 10.1111/os.13273. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the outcomes of open reduction and internal fixation combined with medial buttress plate (MBP) and allograft bone-assisted cannulated screw (CS) fixation for patients with unstable femoral neck fracture with comminuted posteromedial cortex.

METHODS: In a retrospective study of patients operated on for unstable femoral neck fractures with comminuted posteromedial cortex from March 2016 to August 2020, the clinical and radiographic outcomes of 48 patients treated with CS + MBP were compared with the outcomes of 54 patients treated with CS only. All patients in the CS + MBP group were fixed by three CS and MBP (one-third tubular plates or reconstructive plates) with bone allografts. The surgery-related outcomes and complications were evaluated, including operative time, blood loss, union time, femoral head necrosis, femoral neck shortening, and other complications after the operation. The Harris score was evaluated at 12 months after the operation.

RESULTS: All patients were followed up for 12-40 months. The average age of patients in the CS-only group (54 cases, 22 females) and CS + MBP group (48 cases, 20 females) was 48.46 ± 7.26 and 48.73 ± 6.38 years, respectively. More intraoperative blood loss was observed in the CS + MBP group than that of patients in CS-only group (153.45 ± 64.27 vs 21.86 ± 18.19 ml, t = 4.058, P = 0.015). The average operative time for patients in the CS + MBP group (75.35 ± 27.67 min) was almost double than that of patients in the CS-only group (36.87 ± 15.39 min) (t = 2.455, P < 0.001). The Garden alignment index of patients treated by CS + MBP from type I to type IV was 79%, 19%, 2%, and 0%, respectively. On the contrary, they were 31%, 43%, 24% and 2% for those in the CS-only group, respectively. The average healing times for the CS-only and CS + MBP groups were 4.34 ± 1.46 and 3.65 ± 1.85 months (t = 1.650, P = 0.102), respectively. Femoral neck shortening was better in the CS + MBP group (1.40 ± 1.73 mm, 9/19) than that in the CS-only group (4.33 ± 3.32 mm, 24/44). Significantly higher hip function was found in the CS + MBP group (85.60 ± 4.36 vs 82.47 ± 6.33, t = 1.899, P = 0.06). There was no statistical difference between femoral head necrosis (4% vs 11%, χ² = 1.695, P = 0.193) and nonunion (6% vs 9%, χ² = 0.318, P = 0.719).

CONCLUSION: For unstable femoral neck fractures with comminuted posteromedial cortex, additional MBP combined with bone allografts showed better reduction quality and neck length control than CS fixation only, with longer operative time and more blood loss.

PMID:35445587 | DOI:10.1111/os.13273

J Cell Mol Med. 2022 Apr 21. doi: 10.1111/jcmm.17313. Online ahead of print.

ABSTRACT

Duodenal biopsies are considered a suitable source of enterocytes for studies of dietary iron absorption. However, the expression level of molecules involved in iron absorption may vary along the length of duodenum. We aimed to determine whether the expression of molecules involved in the absorption of heme and non-heme iron differs depending on the location in the duodenum. Analysis was performed with samples of duodenal biopsies from 10 individuals with normal iron metabolism. Samples were collected at the following locations: (a) immediately post-bulbar, (b) 1-2 cm below the papilla of Vater and (c) in the distal duodenum. The gene expression was analyzed at the mRNA and protein level using real-time PCR and Western blot analysis. At the mRNA level, significantly different expression of HCP1, DMT1, ferroportin and Zip8 was found at individual positions of duodenum. Position-dependent expression of other molecules, especially of FLVCR1, HMOX1 and HMOX2 was also detected but with no statistical significances. At the protein level, we observed statistically significantly decreasing expression of transporters HCP1, FLVCR1, DMT1, ferroportin, Zip14 and Zip8 with advancing positions of duodenum. Our results are consistent with a gradient of diminishing iron absorption along the duodenum for both heme and non-heme iron.

PMID:35445529 | DOI:10.1111/jcmm.17313

Asia Pac J Clin Oncol. 2022 Apr 20. doi: 10.1111/ajco.13658. Online ahead of print.

ABSTRACT

BACKGROUND: Pemetrexed was approved by United States Food and Drug Administration (US FDA) in combination with platinum for the treatment of advanced nonsquamous non-small cell lung carcinoma (NSCLC) and malignant mesothelioma. Bevacizumab and pembrolizumab can be added to chemotherapy for patients with nonsquamous NSCLC with benefits but there has not been any dedicated head-to-head comparison between pembrolizumab-pemetrexed-platinum (PAC) and bevacizumab-pemetrexed-platinum (BAC) on their efficacy and safety.

METHODS: This was a retrospective single-center cohort study conducted in Queen Mary Hospital in Hong Kong. The study included 451 patients with advanced stage nonsquamous NSCLC that received first-line pemetrexed and platinum with or without bevacizumab or pembrolizumab. Patients who received pemetrexed-platinum (AC) were compared with those who received PAC and BAC. The primary endpoint was the progression-free survival (PFS).

RESULTS: The median PFS for patients that received PAC was significantly longer than those who received BAC and AC (9 months vs. 6.8 months vs. 4.8 months, p < 0.05 among all three groups), with OR of 0.578 (95% CI, 0.343-0.976; p = 0.040) and 0.430 (95% CI, 0.273-0.675; p < 0.001) when compared to BAC and AC, respectively. Patients who received PAC also had a higher disease control rate and higher likelihood to receive continuation maintenance therapy than those on AC. There is no statistically significant difference in the grade 3 to 4 toxicity among the three treatment groups.

CONCLUSIONS: Although both regimens are superior to pemetrexed-platinum alone, data from this retrospective single center study suggested a better PFS in advanced stage nonsquamous NSCLC patient treated with first-line pembrolizumab-pemetrexed-platinum than bevacizumab-pemetrexed-platinum without an obvious increase in significant toxicity.

PMID:35445527 | DOI:10.1111/ajco.13658

J Appl Res Intellect Disabil. 2022 Apr 20. doi: 10.1111/jar.12999. Online ahead of print.

ABSTRACT

BACKGROUND: Poor health-related physical fitness (HRPF) and overweight and obesity are common health problems for children with intellectual disability. This study aimed to review existing lifestyle intervention studies, and identify effective strategies for this population.

METHODS: A systematic search was undertaken in three databases. The random-effects model was used to pool the weighted results by inverse variance methods, and the I² statistic was applied to assess heterogeneity among the included studies.

RESULTS: Most of the identified interventions (27/29) adopted physical activity (PA). For obesity-related outcomes, the results showed no significant effect of PA studies on reducing obesity. For HRPF outcomes, significant effects were found on 6-min walk distance (51.86 m, 95% CI [16.49, 87.22], p < .05).

CONCLUSIONS: PA is the predominant intervention component adopted and may contribute to improving cardiopulmonary fitness; but the lack of research limits our ability to draw any confirmed conclusion on obesity-related outcomes and other HRPF outcomes.

PMID:35445495 | DOI:10.1111/jar.12999

Ann Noninvasive Electrocardiol. 2022 Apr 21:e12954. doi: 10.1111/anec.12954. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients.

METHODS: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared.

RESULTS: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p = .005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols.

CONCLUSION: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.

PMID:35445488 | DOI:10.1111/anec.12954

Int J Health Plann Manage. 2022 Apr 20. doi: 10.1002/hpm.3478. Online ahead of print.

ABSTRACT

INTRODUCTION: In recent years, China’s economy has grown rapidly, and the health condition of Chinese residents has significantly improved. However, this rapid economic and social development has also brought a series of environmental problems, such as serious haze pollution, of which the main contents are PM_2.5 particles. The objective of this study is to quantitatively estimate the PM_2.5 -related health costs in China.

METHODS: Based on city-level data from 140 major Chinese cities as well as the Beijing-Tianjin-Hebei, Yangtze River Delta, and Pearl River Delta city clusters in 2010, the value of a statistical life method based on willingness to pay was employed. Moreover, global and local Moran’s I values were calculated to examine the spatial distribution of the health cost of haze pollution in China.

RESULTS: In areas with heavy haze pollution or a high level of economic development, residents’ health costs will also be higher. In addition, there is a spatial aggregation phenomenon in the spatial distribution of health costs in China, which is mainly in the form of “high-high” aggregation, with high-value cities converging with other high-value cities.

CONCLUSIONS: The health cost of haze pollution in China is very considerable, and there are regional differences.

PMID:35445442 | DOI:10.1002/hpm.3478