Nevin Manimala

Ceska Gynekol. 2022 Fall;87(5):317-323. doi: 10.48095/cccg2022317.

ABSTRACT

OBJECTIVE: Evaluation of the effect of manual lymphatic drainage on lymphedema of the upper limb after previous axillary lymphadenectomy/sentinel node bio-psy during the maintenance phase of lymphedema after the breast cancer surgery.

MATERIAL AND METHODS: A total of 30 patients after surgical treatment of unilateral breast cancer underwent 10 manual lymphatic drainages within 8 consecutive weeks. All patients underwent upper limb circumference measurements before and after the study and completed two specialized EORTC questionnaires (QLQ-C30 and QLQ-BR23).

RESULTS: The average time between surgery and admission into this study was 32.5 months. In the beginning of the study, lymphedema was present for an average of 19.8 months. At the end of a series of manual lymphatic drainages, the average volume decrease of the limb with lymphedema was 3% (1.5-5.6%). In contrary, the average loss of volume on the healthy (control) upper limb was only 0.4%. The average reduction of lymphedema volume after therapy achieved 57% (37-88%). After a series of manual lymphatic drainages, the results of the EORTC QLQ-C30 questionnaire showed a statistically significant improvement in physical and role functions, fatigue, nausea and vomiting, pain, dyspnea and constipation, while the results of the EORTC QLQ-BR23 questionnaire showed a statistically significant improvement in the arm and breast symptoms. There was no statistically significant deterioration in any of the monitored parameters.

CONCLUSION: The results of the study showed a positive effect of manual lymphatic drainage on the maintenance phase of lymphedema in patients after breast cancer surgery. The questionnaires showed a significant improvement in hand and arm symptoms as well as an improvement of the other functions and symptoms affecting quality of life. Further studies should be performed on groups of patients with the maintenance phase of upper limb lymphedema to confirm or disprove our results.

PMID:36316211 | DOI:10.48095/cccg2022317

Environ Sci Technol. 2022 Oct 31. doi: 10.1021/acs.est.2c05266. Online ahead of print.

ABSTRACT

Aerosol iron (Fe) solubility is a key factor for the assessment of atmospheric nutrients input to the ocean but poorly specified in models because the mechanism of determining the solubility is unclear. We develop a deep learning model to project the solubility based on the data that we observed in a coastal city of China. The model has five variables: the size range of particles, relative humidity, and the ratios of sulfate, nitrate and oxalate to total Fe (TFe) contents in aerosol particles. Results show excellent statistical agreements with the solubility in the literature over most worldwide seas and margin areas with the Pearson correlation coefficients (r) as large as 0.73-0.97. The exception is the Atlantic Ocean, where good agreement is obtained with the model trained using local data (r: 0.34-0.66). The model further uncovers that the ratio of oxalate/TFe is the most important variable influencing the solubility. These results indicate the feasibility of treating the solubility as a function of the six factors in deep learning models with careful training and validation. Our model and projected solubility provide innovative options for better quantification of air-to-sea input of aerosol soluble Fe in observational and model studies in the global marine atmosphere.

PMID:36316194 | DOI:10.1021/acs.est.2c05266

J Korean Assoc Oral Maxillofac Surg. 2022 Oct 31;48(5):303-308. doi: 10.5125/jkaoms.2022.48.5.303.

ABSTRACT

OBJECTIVES: Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and.

METHODS: Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography.

RESULTS: A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment.

CONCLUSION: No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

PMID:36316189 | DOI:10.5125/jkaoms.2022.48.5.303

J Korean Assoc Oral Maxillofac Surg. 2022 Oct 31;48(5):292-296. doi: 10.5125/jkaoms.2022.48.5.292.

ABSTRACT

OBJECTIVES: During Le Fort I osteotomy, the separation of the pterygomaxillary junction (PMJ) is a difficult procedure for most surgeons because it is invisible. In this process, damage to the posterior structures constituting the sinus or those adjacent to it, including the maxillary sinus posterior wall and pterygoid plate, may occur. We would like to investigate the effects of this on the inside of the maxillary sinus after surgery and whether there are complications.

MATERIALS AND METHODS: One-hundred patients who underwent Le Fort I osteotomy from 2013 to 2020 using cone-beam computed tomography images were classified into two groups (clean-cut type and fractured type) according to the PMJ cutting pattern. In addition, the mucosal thickness in the maxillary sinus was divided into preoperative, postoperative three months, one year, and the change over the course of surgery was evaluated retrospectively.

RESULTS: Of the total 100 cases, the clean-cut type numbered 28 cases and the fractured type totaled 72 cases. Among the fracture types, part of the sinus wall and the pterygoid plate were broken in 69 cases, and the maxillary sinus posterior wall was detached in three cases. There was no statistically significant difference in sinus mucosal thickening between the clean-cut type and fractured type of the PMJ, three months and one year after surgery between the two groups. However, there was a significant difference in sinus mucosal thickness at postoperative one year in the case where a partial detachment of the maxillary sinus posterior wall occurred compared to not.

CONCLUSION: Even if there is some damage to the structures behind the PMJ, it may not be reasonable to spend some time on the PMJ separation process considering the overall postoperative complications, if there is no significant difference inside the sinus, or increased probability of postoperative complications.

PMID:36316187 | DOI:10.5125/jkaoms.2022.48.5.292

J Korean Assoc Oral Maxillofac Surg. 2022 Oct 31;48(5):284-291. doi: 10.5125/jkaoms.2022.48.5.284.

ABSTRACT

OBJECTIVES: This study aimed to analyze the clinicopathological prognostic factors affecting the survival of patients with oral squamous cell carcinoma (OSCC).

MATERIALS AND METHODS: A retrospective study was conducted on patients with OSCC who received treatment at the Oral Oncology Clinic of the National Cancer Center (NCC) from June 2001 to December 2020. The patients’ sex, age, primary site, T stage, node metastasis, TNM staging, perineural invasion (PNI), lymphovascular invasion (LVI), differentiation, surgical resection margin, smoking, and drinking habits were investigated to analyze risk factors. For the univariate analysis, a Kaplan-Meier survival analysis and log-rank test were used. Additionally, for the multivariable analysis, a Cox proportional hazard model analysis was used. For both analyses, statistical significance was considered when P<0.05.

RESULTS: During the investigation period, 407 patients were received surgical treatment at the NCC. Their overall survival rate (OS) for five years was 70.7%, and the disease-free survival rate (DFS) was 60.6%. The multivariable analysis revealed that node metastasis, PNI, and differentiation were significantly associated with poor OS. For DFS, PNI and differentiation were associated with poor survival rates.

CONCLUSION: In patients with OSCC, cervical node metastasis, PNI, and differentiation should be considered important prognostic factors for postoperative survival.

PMID:36316186 | DOI:10.5125/jkaoms.2022.48.5.284

Clin Chem. 2022 Nov 1:hvac155. doi: 10.1093/clinchem/hvac155. Online ahead of print.

NO ABSTRACT

PMID:36316167 | DOI:10.1093/clinchem/hvac155

Br J Gen Pract. 2022 Sep 30:BJGP.2022.0271. doi: 10.3399/BJGP.2022.0271. Online ahead of print.

ABSTRACT

BACKGROUND: GPs and patients value continuity of care. Ethnic differences in continuity could contribute to inequalities in experience and outcomes.

AIM: To describe relational continuity of care in general practice by ethnicity and long-term conditions.

DESIGN AND SETTING: In total, 381 474 patients in England were included from a random sample from the Clinical Practice Research Datalink (January 2016 to December 2019).

METHOD: Face-to-face, telephone, and online consultations with a GP were included. Continuity, measured by the Usual Provider of Care and Bice-Boxerman indices, was calculated for patients with ≥3 consultations. Ethnicity was taken from the GP record or linked Hospital Episode Statistics data, and long-term conditions were counted at baseline. Multilevel regression models were used to describe continuity by ethnicity sequentially adjusted for: a) the number of consultations, follow-up time, age, sex, and practice-level random intercept; b) socioeconomic deprivation in the patient’s residential area; and c) long-term conditions.

RESULTS: On full adjustment, 5 of 10 ethnic minority groups (Bangladeshi, Pakistani, Black African, Black Caribbean, and any other Black background) had lower continuity of care compared with White patients. Continuity was lower for patients in more deprived areas and younger patients but this did not account for ethnic differences in continuity. Differences by ethnicity were also seen in patients with ≥2 long-term conditions.

CONCLUSION: Ethnic minority identity and socioeconomic deprivation have additive associations with lower continuity of care. Structural factors affecting demand for, and supply of, GPs should be assessed for their contribution to ethnic inequalities in relational continuity and other care quality domains.

PMID:36316161 | DOI:10.3399/BJGP.2022.0271

Br J Gen Pract. 2022 Jul 22:BJGP.2022.0118. doi: 10.3399/BJGP.2022.0118. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear how engaging in physical activity after long periods of inactivity provides expected health benefits.

AIM: To determine whether physically inactive primary care patients reduce their mortality risk by increasing physical activity, even in low doses.

DESIGN AND SETTING: Prospective cohort of 3357 physically inactive patients attending 11 Spanish public primary healthcare centres.

METHOD: Change in physical activity was repeatedly measured during patients’ participation in the ‘Experimental Program for Physical Activity Promotion’ clinical trial between 2003 and 2006, using the ‘7-day Physical Activity Recall’. Mortality to 31 December 2018 (312 deaths) was recorded from national statistics, and survival time from the end of the clinical trial analysed using proportional hazard models.

RESULTS: After 46 191 person-years of follow-up, compared with individuals who remained physically inactive, the mortality rates of those who achieved the minimum recommendations of 150- 300 min/ week of moderate- or 75-150 min/ week of vigorous-intensity exercise was reduced by 45% (adjusted hazard ratio [aHR] 0.55; 95% confidence interval [95% CI] = 0.41 to 0.74); those who did not meet these recommendations but increased physical activity in low doses, that is, 50 min/week of moderate physical activity, showed a 31% reduced mortality (aHR 0.69, 95% CI = 0.51 to 0.93); and, those who surpassed the recommendation saw a 49% reduction in mortality (aHR 0.51, 95% CI = 0.32 to 0.81). The inverse association between increased physical activity and mortality follows a continuous curvilinear dose-response relationship.

CONCLUSION: Physically inactive primary care patients reduced their risk of mortality by increasing physical activity, even in doses below recommended levels. Greater reduction was achieved through meeting physical activity recommendations or adopting levels of physical activity higher than those recommended.

PMID:36316160 | DOI:10.3399/BJGP.2022.0118

Neuroradiol J. 2022 Oct 31:19714009221114445. doi: 10.1177/19714009221114445. Online ahead of print.

ABSTRACT

PURPOSE: The purpose is to determine the inter-rater reliability in grading ASPECTS score, between emergency medicine physician at first contact and radiologist among patients with acute ischemic stroke.

MATERIALS AND METHODS: We conducted a prospective analysis of 765 acute ischemic stroke cases referred to the Department of Radiodiagnosis in a rural-based hospital in South India, during January 2017 to October 2021. Non-contrast computed tomography (NCCT) scans of the brain were performed using GE Bright Speed Elite 128 Slice CT Scanner. ASPECTS score was calculated separately by an emergency medicine physician and radiologist. Inter-rater reliability for total and dichotomized ASPECTS (≥6 and <6) scores were assessed using statistical analysis (ICC and Cohen ĸ coefficients) on SPSS software (v17.0).

RESULTS: Inter-rater agreement for total and dichotomized ASPECTS was substantial (ICC 0.79 and Cohen ĸ 0.68) between the emergency physician and the radiologist. Mean difference in ASPECTS between the two readers was only 0.15 with standard deviation of 1.58. No proportionality bias was detected. The Bland-Altman plot was constructed to demonstrate the distribution of ASPECTS differences between the two readers.

CONCLUSION: Substantial inter-rater agreement was noted in grading ASPECTS between emergency medicine physician at first contact and radiologist, thereby confirming its robustness even in a rural setting.

PMID:36316159 | DOI:10.1177/19714009221114445

J Epidemiol Community Health. 2022 Oct 31:jech-2022-219521. doi: 10.1136/jech-2022-219521. Online ahead of print.

ABSTRACT

BACKGROUND: It is not known how differences in COVID-19 deaths by migration background in the Netherlands evolved throughout the pandemic, especially after introduction of COVID-19 prevention measures targeted at populations with a migration background (in the second wave). We investigated associations between migration background and COVID-19 deaths across first wave of the pandemic, interwave period and second wave in the Netherlands.

METHODS: We obtained multiple registry data from Statistics Netherlands spanning from 1 March 2020 to 14 March 2021 comprising 17.4 million inhabitants. We estimated incidence rate ratios for COVID-19 deaths by migration background using Poisson regression models and adjusted for relevant sociodemographic factors.

RESULTS: Populations with a migration background, especially those with Turkish, Moroccan and Surinamese background, exhibited higher risk of COVID-19 deaths than the Dutch origin population throughout the study periods. The elevated risk of COVID-19 deaths among populations with a migration background (as compared with Dutch origin population) was around 30% higher in the second wave than in the first wave.

CONCLUSIONS: Differences in COVID-19 deaths by migration background persisted in the second wave despite introduction of COVID-19 prevention measures targeted at populations with a migration background in the second wave. Research on explanatory mechanisms and novel prevention measures are needed to address the ongoing differences in COVID-19 deaths by migration background.

PMID:36316152 | DOI:10.1136/jech-2022-219521