Nevin Manimala

Scand J Med Sci Sports. 2022 Nov 20. doi: 10.1111/sms.14274. Online ahead of print.

ABSTRACT

BACKGROUND: Walking cadence (steps/min) has emerged as a valid proxy of physical activity intensity, with consensus across numerous laboratory-based treadmill studies that ≥100 steps/min approximates absolutely-defined moderate intensity (≥3 metabolic equivalents; METs). We recently reported that this cadence threshold had a classification accuracy of 73.3% for identifying moderate intensity during preferred pace overground walking in young adults. The purpose of this study was to evaluate and compare the performance of a cadence threshold of ≥100 steps/min for correctly classifying moderate intensity during overground walking in middle- and older-aged adults.

METHODS: Participants (N=174, 48.3% female, 41-85 years of age) completed laboratory-based cross-sectional study involving an indoor 5-min overground walking trial at their preferred pace. Steps were manually counted and converted to cadence (total steps/5 min). Intensity was measured using indirect calorimetry and expressed as METs. Classification accuracy (sensitivity, specificity, accuracy) of a cadence threshold of ≥100 steps/min to identify individuals walking at ≥3 METs was calculated.

RESULTS: The ≥100 steps/min threshold demonstrated accuracy of 74.7% for classifying moderate intensity. When comparing middle- vs. older-aged adults, similar accuracy (73.4% vs. 75.8%, respectively) and specificity (33.3% vs. 34.5%) were observed. Sensitivity was high, but was lower for middle- vs. older-aged adults (85.2% vs. 93.9, respectively).

CONCLUSION: A cadence threshold of ≥100 steps/min accurately identified moderate intensity overground walking. Furthermore, accuracy was similar when comparing middle- and older-aged adults. These findings extend our previous analysis in younger adults and confirm the appropriateness of applying this cadence threshold across the adult lifespan.

PMID:36403207 | DOI:10.1111/sms.14274

Breast Cancer Res Treat. 2022 Nov 20. doi: 10.1007/s10549-022-06799-7. Online ahead of print.

ABSTRACT

PURPOSE: Current systemic therapy guidelines for patients with HER2 + breast cancer brain metastases (BCBrM) diverge based on the status of extracranial disease (ECD). An in-depth understanding of the impact of ECD on outcomes in HER2 + BCBrM has never been performed. Our study explores the implications of ECD status on intracranial progression-free survival (iPFS) and overall survival (OS) after first incidence of HER2 + BCBrM and radiation.

METHODS: A retrospective analysis was performed of 151 patients diagnosed with initial HER2 + BCBrM who received radiation therapy to the central nervous system (CNS) at Duke between 2008 and 2021. The primary endpoint was iPFS defined as the time from first CNS radiation treatment to intracranial progression or death. OS was defined as the time from first CNS radiation or first metastatic disease to death. Systemic staging scans within 30 days of initial BCBrM defined ECD status as progressive, stable/responding or none (isolated brain relapse).

RESULTS: In this cohort, > 70% of patients had controlled ECD with either isolated brain relapse (27%) or stable/responding ECD (44%). OS from initial metastatic disease to death was markedly worse for patients with isolated intracranial relapse (median = 28.4 m) compared to those with progressive or stable/responding ECD (48.8 m and 71.5 m, respectively, p = 0.0028). OS from first CNS radiation to death was significantly worse for patients with progressive ECD (16.9 m) versus stable/responding (36.6 m) or isolated intracranial relapse (28.4 m, p = 0.007). iPFS did not differ statistically based on ECD status. Receipt of systemic therapy after first BCBrM significantly improved iPFS (HR 0.45, 95% CI: 0.25-0.81, p = 0.008) and OS (HR: 0.43 (95% CI: 0.23-0.81); p = 0.001).

CONCLUSION: OS in patients with HER2 + isolated BCBrM was inferior to those with concurrent progressive or stable/responding ECD. Studies investigating initiation of brain-penetrable HER2-targeted therapies earlier in the disease course of isolated HER2 + intracranial relapse patients are warranted.

PMID:36403183 | DOI:10.1007/s10549-022-06799-7

Breast Cancer Res Treat. 2022 Nov 20. doi: 10.1007/s10549-022-06811-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the study was to analyze the impact of neoadjuvant systemic treatment (NST) on postoperative complications and the beginning of adjuvant treatment.

METHODS: This study includes data from a prospectively maintained database including patients with breast cancer (BC) stage I-IV with or without NST undergoing breast cancer surgery between January 2010 and September 2021.

RESULTS: Out of 517 enrolled patients, 77 received NST, 440 had primary breast surgery. After NST patients underwent surgery after a meantime of 34 days (26.5-40 days). No statistical significance could be found comparing the complication grading according to the Clavien Dindo classification. The complications were most frequently rated as grade 3b. There were no complications with grade 4 or higher. When differentiating into short and long-term, the overall rate of short-term complications was 20.3% with no significant difference between the two groups (20.8% vs. 20.2%). Regarding long-term complications, there was more impairment of shoulder mobility (26.0% vs. 9.5%, p ≤ 0.001) and chronic pain (42.9% vs. 28.6%, p ≤ 0.016) for patients with NST. The beginning of the administration of the adjuvant treatment was comparable in both groups (46.3 days vs. 50.5 days).

CONCLUSION: In our cohort, complications between both groups were comparable according to Clavien Dindo. This study shows that NST has no negative impact on postoperative short-term complications and most importantly did not lead to a delay of the beginning of adjuvant treatment. Therefore, NST can be safely admitted, even when followed by extensive breast reconstruction surgery.

PMID:36403182 | DOI:10.1007/s10549-022-06811-0

Acta Odontol Scand. 2022 Nov 20:1-6. doi: 10.1080/00016357.2022.2146746. Online ahead of print.

ABSTRACT

OBJECTIVE: Hormonal factors have been suggested to contribute to female dominance among subjects with temporomandibular disorders (TMD). Aim of the study was to examine the association of climacteric status with TMD amongst female participants in the Northern Finland Birth Cohort (NFBC) 1966 at 46 years of age.

MATERIAL AND METHODS: Among female subjects in NFBC1966, climacteric status was determined based on menstrual anamnesis and measurement of blood follicle-stimulating hormone (FSH) levels. Women with FSH > 25 IU/L and amenorrhoea > 4 months were defined as climacteric (case group, n = 71); women not diagnosed as climacteric were defined as preclimacteric (control group, n = 656). Differences between cases and controls were evaluated on self-reported TMD pain, clinical TMD signs and TMD diagnoses using modified Diagnostic Criteria for TMD (DC/TMD) protocol. Crosstabulation and logistic regression models were used to analyse differences between cases and controls.

RESULTS: Compared to preclimacteric women, climacteric women had significantly more often pain on palpation in temporomandibular joints (TMJs) (OR = 2.64, 95% CI 1.12-6.21, p= .026) and more crepitus in TMJs (OR = 2.92, 95% CI 1.13-7.56, p= .027). Degenerative joint disease diagnoses were more common in climacteric than preclimacteric women (OR = 2.27, 95% CI 1.05-4.91, p= .037). Differences were statistically significant after adjusting for confounding factors (body mass index (BMI), smoking, parity). No statistically significant differences in self-reported TMD pain were noted between groups.

CONCLUSION: Among females at the age of 46 years, climacterium seems associated with TMD by increasing pain on palpation in TMJs, subjective symptoms, and clinical signs indicating degenerative changes in TMJs when using DC/TMD.

PMID:36403169 | DOI:10.1080/00016357.2022.2146746

Arch Environ Contam Toxicol. 2022 Nov 20. doi: 10.1007/s00244-022-00966-z. Online ahead of print.

ABSTRACT

The present study investigated the temporal variability of surface ozone and its nitrogen precursors at the proximity of a traffic crossroad (≈ 22,580 vehicles per day) located in a coastal suburban site of Sfax city (Tunisia). It was performed during January-October, 2010. The study results show that the surface ozone is characterized by a slightly modulated regime between day and night. At traffic-peak hours, the decrease of ozone concentration levels is due to the oxidation reaction of NO into NO₂. Complementary statistical approaches (inter-variable correlation matrix, cluster analysis, representation quality of variables and multiple regression analysis) reveal that the excess of O₃ is mainly affected by the wind speed, temperature, solar radiation and NO₂ with contribution rates of 127, 21, 22 and 12%, respectively. The decrease of O₃ is, however, controlled by NO, relative humidity and boundary layer height with contribution rates of 25, 21 and 16%, respectively. The regional daytime and night-time contributions to O₃ are very different. The daytime intercept which is greater than that of night-time indicates there was a large NO_x independent regional contribution. This could be attributed to the biogenic VOCs effect interfering in the photochemical cycle. It, therefore, implies that the study site is VOC-sensitive. The investigation of the air quality index (AQI) for O₃ and NO₂ showed that more than 86% of the total studied period has a good quality level. Only about 14% of total days are characterized by an acceptable air quality level, however, for a very small number of people are unusually sensitive to air pollution.

PMID:36403166 | DOI:10.1007/s00244-022-00966-z

J Cosmet Laser Ther. 2022 Nov 20:1-7. doi: 10.1080/14764172.2022.2148186. Online ahead of print.

ABSTRACT

Laser-assisted drug delivery (LADD) is a new treatment for delivering drugs within the skin. This meta-analysis investigates the effectiveness and safety of the laser-assisted delivery of tranexamic acid (TXA) to treat melasma. A literature review was conducted by searching publication platforms to search for randomized controlled trials (RCTs) that compared laser-assisted delivery of TXA with laser-alone or topical TXA-alone treatment. The Embase, Web of Science, PubMed, Google Scholar, and Cochrane Library databases were searched, and Melasma Area Severity Index (MASI)/modified MASI (mMASI) scores used as the clinical improvement outcomes. All statistical analyses were performed using the RevMan software (Review Manager, V.5.3). The standardized mean differences and 95% confidence intervals were used to assess the results. Five RCTs were included in this meta-analysis. These studies used ablative fractional photothermolysis and nonablative dermal remodeling laser modalities. The results showed that both laser modalities combined with TXA significantly decreased the MASI/mMASI scores (P = .0003). Furthermore, no serious adverse events were observed, except mild erythema and burning pain. The meta-analysis found that the laser-assisted delivery of TXA is a new effective and safe treatment option for melasma treatment.

PMID:36403155 | DOI:10.1080/14764172.2022.2148186

Top Stroke Rehabil. 2022 Nov 20:1-14. doi: 10.1080/10749357.2022.2145761. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Informal caregivers of stroke survivors often report the need for training on how to care for a loved one with functional mobility limitations. Evidence on training interventions to help informal caregivers with issues related to mobility is varied. The objective of this scoping review was to examine the literature including skill-based training interventions that educate caregivers on functional mobility for stroke survivors.

RESEARCH DESIGN AND METHODS: We extracted studies from OVID Medline, Cochrane, ISI Web of Knowledge, and Embase published between 1990 and 2021. At every stage of assessment, data extraction forms were used to reach consensus among at least three out of four authors. We followed PRISMA-ScR guidelines and Arskey and O’Malley’s framework to chart information into several tables based on research questions and summarized with descriptive statistics.

RESULTS: Most studies were conducted outside the US focused on training in mobility and activities of daily living. The stroke survivor, on average, was an older individual (mean age 64.8 [SD = 5.3] years). The informal caregiver was predominately a younger female spouse (mean age 54.2 [SD = 6.3]). More than a third of the studies reported improvement in the stroke survivors’ physical function post-intervention, with a mean follow-up time of 4.4 months. Effective studies tended to include stroke survivors with less cognitive and functional mobility limitations at higher training dosages.

DISCUSSION AND IMPLICATIONS: Gaps in our understanding of informal caregiver training for those caring for stroke survivors are identified, and recommendations are provided for future research.

PMID:36403145 | DOI:10.1080/10749357.2022.2145761

J Gastroenterol Hepatol. 2022 Nov 20. doi: 10.1111/jgh.16064. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Less attentions are paid into the adolescents and young adults (AYAs) diagnosed with gastric cancer (GC). Our study aims to explore incidence rate trend, death rate trend, and prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in AYAs with GC.

METHODS: A retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) database was performed. Joinpoint regression analysis was used to calculate average annual percent change (AAPC) with 95% confidence interval (CI) for incidence and death rate trends. Prognostic factors for OS and CSS were investigated using Cox proportional hazard model and gray test, respectively, with results shown as hazard ratio (HR) with 95% CI.

RESULTS: Although no statistical significance, incidence rate trend showed a tendency to an increase in AYAs (AAPC = 0.2, 95% CI: -0.2 to 0.6). All-cause death rate trends were declined both in AYAs and middle-aged and elderly people (MAEP), with AAPC value of -0.6 (95% CI: -0.8 to -0.5) and -0.5 (95% CI: -0.6 to -0.4), respectively. AYAs had a lower risk of all-cause death (HR: 0.87, 95% CI: 0.84 to 0.90) but a higher risk of GC-specific death (HR: 1.11, 95% CI: 1.07 to 1.15) than MAEP. Chemotherapy (HR: 1.27, 95% CI: 1.16 to 1.40) and intraoperative radiation (HR: 2.89, 95% CI: 1.13 to 7.37) were respectively identified as risk factors for worse OS and CSS in AYAs.

CONCLUSIONS: AYAs had a higher risk of GC-specific death, indicating more attention should be paid into AYAs with GC.

PMID:36403128 | DOI:10.1111/jgh.16064

Nurs Open. 2022 Nov 20. doi: 10.1002/nop2.1489. Online ahead of print.

ABSTRACT

AIM: The purpose of this study is to explore the influence of self-management intervention on four prognostic indicators of readmission rate, mortality rate, self-management ability and quality of life in patients with chronic heart failure.

DESIGN: A meta-analysis.

METHODS: This study was selected from the related studies published from January 1999 to January 2022, and was searched by searching five databases: PubMed, Science of Website, China National Knowledge Infrastructure (CNKI), Wan Fang and Wei Pu (VIP). All standardized randomized controlled trial studies were collected, and the quality evaluation and meta-analysis of the included literature were conducted.

RESULTS: This study included 20 randomized controlled trials involving 3459 patients with chronic heart failure. Meta-analysis results showed that self-management intervention could reduce the readmission rate of patients with chronic heart failure, improved self-management ability of patients, improved quality of life, but there was no statistical significance in mortality.

PMID:36403127 | DOI:10.1002/nop2.1489

J Orthop Res. 2022 Nov 20. doi: 10.1002/jor.25486. Online ahead of print.

ABSTRACT

A cornerstone of evidence-based medicine is the randomized controlled trial (RCT). While randomization seeks to balance study groups on potential confounders, this is not always achieved. Especially in orthopaedic research where RCTs are often of modest size, imbalances can exist and may be a significant issue. We sought to describe whether orthopaedic RCTs assess balancing between study groups, use statistical hypothesis testing to compare baseline characteristics between groups, and have balanced baseline characteristics between groups. All RCTs from four leading orthopedic journals published between July, 2019 and June, 2020 were identified and those reporting original trial results reviewed for discussion of balancing, use of statistical significance testing to compare baseline characteristics, and patient reported outcome measures (PROMs) at baseline. Standardized mean differences (SMD) of baseline PROMs were calculated to assess balancing. Of 86 orthopaedic RCTs reviewed, 59 (69%) assessed balancing and 50 (58%) used statistical significance testing to compare baseline characteristics. Of 74 articles specifying a primary outcome, 33 (45%) used a PROM with 23 (70%) reporting baseline PROM values. Of these articles, 17 (74%) had a difference of less than 0.25 standard deviations (SDs) between groups, 4 (17%) had a difference of between 0.25 and 0.50 SDs, and 3 (13%) had a difference greater than 0.5 SDs. Orthopaedic RCTs usually assess balancing after randomization though there is room for improvement with over half of articles using hypothesis testing to assess baseline differences as opposed to a measure of the magnitude of the difference. This article is protected by copyright. All rights reserved.

PMID:36403124 | DOI:10.1002/jor.25486