Nevin Manimala

Acta Chir Orthop Traumatol Cech. 2022;89(3):188-192.

ABSTRACT

PURPOSE OF THE STUDY The preferred treatment of giant cell tumor of bone is curettage with the use of local adjuvant. If the tumor spreads beyond the bone into soft tissues, en bloc excision should be performed. Intralesional curettage allows joint preservation, but it is associated with a high recurrence rate. The purpose of the study was to identify the risk factors for local recurrence and to compare the functional outcomes after both types of surgical procedures. MATERIAL AND METHODS The group included 16 patients (5 women, 11 men) with giant cell tumor of bone in distal forearm treated at the First Department of Orthopedic Surgery, St. Anne s University Hospital Brno in 2005-2019. The mean age of patients was 38 years (22-53). The follow-up period was 6.75 years (2-15) on average. The most common location of the tumor was distal radius (14). In 6 patients denosumab treatment was indicated. Based on the obtained data, we compared the effects of gender, Campanacci grade, type of surgery and administration of denosumab on the risk of local recurrence. The functional outcomes were evaluated retrospectively based on the Musculoskeletal Tumor Society scoring system for upper limb salvage surgeries. RESULTS Resection and reconstruction using an osteocartilaginous allograft was performed in 9 patients. Seven patients were treated with tumor curettage with bone cement used to fill the cavity. The group of patients who underwent curettage showed a significantly higher mean MSTS score 89% compared to the group of patients with resection with the mean MSTS score 66% (P < 0.05). Local tumor recurrence was reported in 3 patients (18.75%). No statistically significant difference was found in gender, tumor grade, radicality of surgery or administration of targeted therapy with respect to the incidence of local recurrence. Altogether 6 complications (37.5%) were observed in the group. DISCUSSION The treatment of a giant cell tumor of bone aims to completely remove the tumor and to preserve the best possible function of the limb. The complications in distal forearm involve particularly an increase incidence of local recurrence and painful or limited range of motion of the wrist. Whereas curettage with the use of local adjuvant is burdened with a higher recurrence rate, resection with allograft reconstruction of bone defect is usually associated with poorer functional outcomes. CONCLUSIONS Tumor curettage using local adjuvant is preferred in a well-circumscribed tumor and offers an excellent functional outcome. En bloc tumor resection and reconstruction using an osteocartilaginous allograft is a suitable treatment option for a locally advanced tumor with a low risk of local recurrence. Key words: giant cell tumor of bone, distal radius, distal ulna, curettage, osteocartilaginous allograft.

PMID:35815484

Ann Palliat Med. 2022 Jul 6:apm-22-301. doi: 10.21037/apm-22-301. Online ahead of print.

ABSTRACT

BACKGROUND: Early specialty palliative care (PC) integration improves oncologic outcomes. We aimed to examine longitudinal relationships between specialty PC and palliative radiotherapy (RT), temporal distribution of symptoms, and predictors of earlier specialty PC.

METHODS: We retrospectively reviewed 135 patients with metastatic cancer who received palliative RT at our institution (7/2017-2/2018) and who had died by final study follow-up (6/2021). Descriptive statistics summarized frequencies of clinical visits and symptoms over relative survival time (quartiles 1-3: first 75% of life remaining from metastatic diagnosis to death versus quartile 4: last 25% of life remaining from metastatic diagnosis to death). Logistic regression analyses revealed predictors of receiving earlier (quartiles 1-3) versus later (quartile 4) specialty PC.

RESULTS: There were 16.3%, 10.4%, 26.7%, and 46.7% of palliative RT consultations, compared to 4.7%, 7.6%, 14.0%, and 73.7% of specialty PC visits, that occurred in quartiles 1, 2, 3, and 4, respectively. On multivariable analysis, pain significantly predicted for receiving earlier specialty PC [odds ratios (OR) =15.34; 95% confidence interval (CI): 2.16-324.23; P=0.020], while patients with =2 prior chemotherapy regimens were less likely to have received earlier specialty PC (OR =0.16; 95% CI: 0.04-0.58; P=0.009). The most common reasons for first specialty PC visit were addressing pain (61.0%) and goals of care (19.5%). Overall, 73.3% (99/135) of patients were referred to hospice and 9.6% (13/135) received either palliative RT, chemotherapy, or surgery within 30 days of death.

CONCLUSIONS: Nearly 47% of palliative RT visits compared with 74% of specialty PC visits occurred in the last quarter of life from metastatic diagnosis to death. Multidisciplinary efforts are needed to manage longitudinal symptoms and offer goal-concordant care.

PMID:35815448 | DOI:10.21037/apm-22-301

Hosp Pediatr. 2022 Jul 11:e2022006545. doi: 10.1542/hpeds.2022-006545. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Throughout the COVID-19 pandemic, there has been an increase in hospital admissions for adolescents with eating disorders (EDs). However, there is a paucity of information on how this increase has affected hospitalization courses and disposition planning. We sought to describe the changes in hospitalizations for EDs at our institution during the pandemic.

METHODS: We reviewed charts of patients admitted to our academic medical center for nutritional restoration from January 1, 2017, to June 30, 2021. We report differences in patient characteristics and hospitalization courses using descriptive statistics and Poisson regression.

RESULTS: We reviewed charts for 85 patients for 108 hospital admissions. Admissions increased from 1.4 per month prepandemic to 3.6 per month during the pandemic (P < .001). Most patients were female (91%), White (79%), had private insurance, (80%) and had restrictive eating behaviors (97%). During the pandemic, we found (1) an increase in the average length of stay (12.6 days vs. 18.0 days) with younger age associated with longer length of stay (P < .001); (2) more patients requiring psychotropic medication management (11% vs 31%, P = .01); and (3) fewer patients discharged from the hospital with outpatient therapy (43% vs 24%, P = .03).

CONCLUSIONS: In addition to an increase in hospital admissions for ED management during the pandemic, our study highlights the evolving needs of ED patients during their hospitalizations. The implications of longer admissions with higher acuity at discharge represent areas where appropriate adaptations in inpatient management and disposition planning may improve the quality of care for ED patients.

PMID:35815415 | DOI:10.1542/hpeds.2022-006545

Cartilage. 2022 Apr-Jun;13(2):19476035221109242. doi: 10.1177/19476035221109242.

ABSTRACT

OBJECTIVE: Despite an increased interest in treatment options for cartilage lesions of the knee, the relationship between lesion characteristics and the symptoms they elicit is not well understood. We evaluated the relationship between lesion characteristics and the patient-reported outcome measures (PROMs) and compared this with symptoms reported by patients scheduled for knee ligament reconstruction and knee arthroplasty.

DESIGN: Preoperative data, including Lysholm score and The Knee Injury and Osteoarthritis Outcome Score (KOOS), in 90 consecutive patients scheduled for surgery for symptomatic isolated cartilage lesions were prospectively collected.

RESULT: The patients had a mean age of 33.2 years. There were 62 (69%) males. There was no statistically significant difference in PROMs between patients with cartilage lesions smaller or larger than 2 cm², except for the KOOS subscale symptoms, with patients with smaller lesions reporting higher scores, 62.8 (95% confidence interval [CI] 58.3-67.3) vs. 51.9 (95% CI 45.5-58.4), P = 0.005. There was a small correlation between lesion size and Lysholm score. However, when adjusted for age, sex, body mass index, and lesion localization, this effect was not statistically significant. The International Cartilage Regeneration & Joint Preservation Society grade did not affect preoperative PROMs. Cartilage patients reported worse preoperative symptoms than patients scheduled for knee ligament reconstruction, and approaching the symptoms reported by patients scheduled for knee arthroplasty.

CONCLUSION: The size, depth, and location of cartilage lesions have little impact on the symptoms experienced by the patients. Cartilage patients have comparable symptoms to patients scheduled for knee arthroplasty.

PMID:35815409 | DOI:10.1177/19476035221109242

J Bone Miner Res. 2022 Jul 10. doi: 10.1002/jbmr.4649. Online ahead of print.

ABSTRACT

The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modelling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip DXA scans. Statistical shape modelling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number, and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) or severe (grade ≥3) rHOA, hospital diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top ten hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral centre-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital diagnosed HOA and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility. This article is protected by copyright. All rights reserved.

PMID:35811326 | DOI:10.1002/jbmr.4649

BMC Womens Health. 2022 Jul 10;22(1):288. doi: 10.1186/s12905-022-01866-z.

ABSTRACT

BACKGROUND: Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. It causes a burden on both the patients and the fistula centers. The aim of this study was to assess the magnitude and associated factors of obstetric fistula repair failure among women who underwent fistula repair at Yirgalem Hamlin fistula center in Southern Ethiopia.

METHODS: A facility-based retrospective cross-sectional study was conducted among women who underwent fistula repair at Yirgalem Hamlin fistula center, Southern Ethiopia, during the period from January 2016 to December 2020. All 562 women who underwent fistula repair in the last 5 years were included in the study. The data were collected using a pre-tested checklist from September 22 to October 22, 2021. The data were then imported into EPI info-data version 3.1, exported to SPSS version 25, and analyzed. Descriptive and logistic regression analyses were performed, and the significant statistical test was assessed at a 95% confidence interval. Variables with a p value of < 0.05 in multivariable logistic regression were regarded to have a statistically significant relationship.

RESULTS: The magnitude of obstetric fistula repair failure in this study was 28.8%. Obstetric fistula repair failure was found to be associated with labor duration > 48 h (AOR = 2.037; 95% CI 1.268, 3.272), Goh Type 4 fistulas (AOR = 3.939; 95% CI 1.623, 9.560), fistula size > 3 cm (AOR = 6.627; 95% CI 3.802, 11.554), completely destructed urethra (AOR = 3.192; 95% CI 1.234, 8.256), and bladder catheterization > 14 days (AOR = 2.944; 95% CI 1.380, 6.281).

CONCLUSIONS: The magnitude of obstetric fistula repair failure was significantly higher than the World Health Organization standard. Obstetric fistula repair failure had a positive association with a longer duration of labor, Goh Type 4 fistulas, large fistula size, total urethral injury, and a longer period of bladder catheterization. Therefore, the concerned bodies need to implement interventions on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair.

PMID:35811314 | DOI:10.1186/s12905-022-01866-z

J Egypt Natl Canc Inst. 2022 Jul 11;34(1):29. doi: 10.1186/s43046-022-00130-7.

ABSTRACT

BACKGROUND: One of the main limitations of radiation therapy is the resistance of tumor cells. This study aimed at evaluating the relationship between the expression of epidermal growth factor receptor (EGFR) and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) and tumor radiosensitivity in patients with non-small cell lung cancer.

METHODS: Medical case files, pathological results for EGFR and EML4-ALK, and computerized tomography scans of patients with NSCLC treated with thoracic radiation therapy were analyzed.

RESULTS: The sample size was 101 patients with mean age 58.43 ± 9.89 years. Statistically significant differences were observed in the mean reduction of long tumor diameter during the early treatment phase in EGFR-positive versus EGFR-negative patients (p value = 0.04) and in short tumor diameter during the late treatment phase in EGFR-positive versus EGFR-negative patients (p value = 0.04).

CONCLUSION: Patients with overexpression of EGFR mutations are more radiosensitive during the early treatment phase, and EML4-ALK mutations were less radiosensitive regardless of phases.

PMID:35811311 | DOI:10.1186/s43046-022-00130-7

Adv Sci (Weinh). 2022 Jul 10:e2201621. doi: 10.1002/advs.202201621. Online ahead of print.

ABSTRACT

Cognitive decline is amongst one of the most commonly reported complaints during normal aging. Despite evidence that age and cognition are linked with similar neural correlates, no previous studies have directly ascertained how these two constructs overlap in the brain in terms of neuroimaging-based prediction. Based on a long lifespan healthy cohort (CamCAN, aged 19-89 years, n = 567), it is shown that both cognitive function (domains spanning executive function, emotion processing, motor function, and memory) and human age can be reliably predicted from unique patterns of functional connectivity, with models generalizable in two external datasets (n = 533 and n = 453). Results show that cognitive decline and normal aging both manifest decrease within-network connections (especially default mode and ventral attention networks) and increase between-network connections (somatomotor network). Whereas dorsal attention network is an exception, which is highly predictive on cognitive ability but is weakly correlated with aging. Further, the positively weighted connections in predicting fluid intelligence significantly mediate its association with age. Together, these findings offer insights into why normal aging is often associated with cognitive decline in terms of brain network organization, indicating a process of neural dedifferentiation and compensational theory, and providing potential connectivity markers for hinting at multiple cognitive deficits.

PMID:35811304 | DOI:10.1002/advs.202201621

Eur Urol Oncol. 2022 Jul 7:S2588-9311(22)00092-X. doi: 10.1016/j.euo.2022.06.003. Online ahead of print.

ABSTRACT

CONTEXT: Randomized controlled trials (RCTs) have shown that addition of docetaxel or androgen receptor axis-targeted therapy (ARAT) to androgen deprivation therapy (ADT) or addition of ARAT to ADT and docetaxel improves overall survival (OS) in metastatic hormone-sensitive prostate cancer (mHSPC). However, it is unknown whether docetaxel, when given as part of triplet therapy, has an independent OS benefit.

OBJECTIVE: To compare the efficacy of ADT plus ARAT with the triplet of ADT, ARAT, and docetaxel through a network meta-analysis (NMA) of RCTs in mHSPC.

EVIDENCE ACQUISITION: Bibliographic databases and conference proceedings were searched in March 2022 for RCTs that evaluated the addition of docetaxel, ARAT, or both to ADT in mHSPC. The primary endpoint was OS. Standard random-effect NMA and Bayesian analyses were performed to compare ADT plus ARAT with triplet therapy.

EVIDENCE SYNTHESIS: Eleven RCTs (n = 11 546) were eligible. Compared with ADT plus ARAT, the triplet had a nonsignificant OS benefit (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.68-1.16), while ADT plus docetaxel (HR 1.16 [0.94-1.43]) and ADT alone (HR 1.46 [1.30-1.64]) had an increased risk of death. By P-score ordering, the triplet was the most effective treatment strategy (P score = 0.936) followed by ADT plus ARAT (P score = 0.704). The triplet had a 77% likelihood of being the best treatment strategy compared with a 23% likelihood for ADT plus ARAT.

CONCLUSIONS: The triplet of ADT, ARAT, and docetaxel was the highest ranked treatment strategy, but it did not confer a statistically significant OS benefit over ADT plus ARAT. This NMA provides the highest-level comparative evidence for these treatment approaches in the initial management of mHSPC.

PATIENT SUMMARY: We synthesized the available evidence from clinical trials conducted in newly diagnosed metastatic prostate cancer to compare the survival of patients receiving triplet therapy (androgen receptor axis-targeted therapy [ARAT], androgen deprivation therapy [ADT], and docetaxel) with those receiving only ARAT and ADT. We conclude that the triplet is a somewhat more effective treatment approach.

PMID:35811293 | DOI:10.1016/j.euo.2022.06.003

Eur Urol Focus. 2022 Jul 7:S2405-4569(22)00135-3. doi: 10.1016/j.euf.2022.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: European guidelines recommend that well-informed men at elevated risk of having prostate cancer (PCa) should be offered prostate-specific antigen (PSA) testing with risk-stratified follow-up. The Swedish National Board of Health and Welfare recommends against screening for PCa but supports regional implementation of organised prostate cancer testing (OPT).

OBJECTIVE: To report the process for designing and implementing OPT programmes.

DESIGN, SETTING, AND PARTICIPANTS: Population-based OPT programmes in two Swedish regions, designed to include men aged between 50 and 74 yr, launched in September 2020 for 50-yr-old men.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The number of men invited, the participation rate, and the numbers of magnetic resonance imaging (MRI) scans, urological visits, and biopsies from September 2020 to June 2021 were recorded.

RESULTS AND LIMITATIONS: Two Swedish regions co-designed an OPT programme with a risk-stratified diagnostic algorithm based on prostate-specific antigen (PSA), PSA density, MRI findings, and age. An automated administrative system was developed on a nationwide web-based platform. Invitation letters and test results are automatically generated and sent out by post. Men with PSA ≥3ng/ml, a suspicious MRI lesion, and/or PSA density ≥0.15 ng/ml/cm³ are referred for a prostate biopsy. Test results are registered for quality control and research. By June 2021, a total of 16 515 men were invited, of whom 6309 (38%) participated; 147 had an MRI scan and 39 underwent prostate biopsy. The OPT framework, algorithm, and diagnostic pathways have been working well.

CONCLUSIONS: We designed and implemented a framework for OPT with a high grade of automation. The framework and organisational experiences may be of value for others who plan a programme for early detection of PCa.

PATIENT SUMMARY: We describe the implementation of an organised testing programme for early detection of prostate cancer in two Swedish regions. This model is the first of its kind and may serve as a template for similar programmes.

PMID:35811285 | DOI:10.1016/j.euf.2022.06.008