Nevin Manimala

Surg Innov. 2022 Sep 21:15533506221120484. doi: 10.1177/15533506221120484. Online ahead of print.

ABSTRACT

OBJECTIVE: The mainstay of first-line treatment of parotid tumors is adequate surgical removal. The present study was conducted to compare the differences between parotidectomy with postauricular incision (PI) and modified Blair incision (MBI).

DATA SOURCES: A systematic search of PubMed, Embase and the Cochrane Library was performed.

METHODS: The data of interest and study characteristics were extracted from the included studies. Statistical analysis was performed with Comprehensive Meta-Analysis software (version 3; BioStat, Englewood, NJ). Dichotomous data and continuous data were analyzed by calculating the risk difference and the mean difference with the 95% confidence interval respectively.

RESULTS: Four retrospective studies were included in the present meta-analysis. The pooled results revealed that the cosmetic satisfaction score was higher in the PI group (MD = 2.67; 95% CI, 2.12 to 3.23) and that intraoperative blood loss was lower in the PI group (MD = -55.35; 95% CI, -100.33 to -10.36). The operative duration (MD = -5.15; 95% CI, -24.06 to 13.75), tumor size (MD = -.07; 95% CI, -.27 to .13) and incidences of common postoperative complications were comparable between the two groups.

CONCLUSIONS: According to these findings, the use of PI in parotidectomies may be one of the options for improving cosmetic outcomes. This technique may be considered if oncological safety can be secured.

PMID:36128913 | DOI:10.1177/15533506221120484

Stat Methods Med Res. 2022 Sep 21:9622802221122403. doi: 10.1177/09622802221122403. Online ahead of print.

ABSTRACT

Dichotomous response data observed over multiple time points, especially data that exhibit longitudinal structures, are important in many applied fields. The multivariate probit model has been an attractive tool in such situations for its ability to handle correlations among the outcomes, typically by modeling the covariance (correlation) structure of the latent variables. In addition, a multivariate probit model facilitates controlled imputations for nonignorable dropout, a phenomenon commonly observed in clinical trials of experimental drugs or biologic products. While the model is relatively simple to specify, estimation, particularly from a Bayesian perspective that relies on Markov chain Monte Carlo sampling, is not as straightforward. Here we compare five sampling algorithms for the correlation matrix and discuss their merits: a parameter-expanded Metropolis-Hastings algorithm (Zhang et al., 2006), a parameter-expanded Gibbs sampling algorithm (Talhouk et al., 2012), a parameter-expanded Gibbs sampling algorithm with unit constraints on conditional variances (Tang, 2018), a partial autocorrelation parameterization approach (Gaskins et al., 2014), and a semi-partial correlation parameterization approach (Ghosh et al., 2021). We describe each algorithm, use simulation studies to evaluate their performance, and focus on comparison criteria such as computational cost, convergence time, robustness, and ease of implementations. We find that the parameter-expanded Gibbs sampling algorithm by Talhouk et al. (2012) often has the most efficient convergence with relatively low computational complexity, while the partial autocorrelation parameterization approach is more flexible for estimating the correlation matrix of latent variables for typical late phase longitudinal studies.

PMID:36128906 | DOI:10.1177/09622802221122403

J Pathol Transl Med. 2022 Sep;56(5):260-269. doi: 10.4132/jptm.2022.07.05. Epub 2022 Sep 13.

ABSTRACT

BACKGROUND: Gastric-type endocervical adenocarcinoma (GEA) is unrelated to human papillomavirus (HPV) infection and is clinically aggressive compared with HPV-associated usual-type endocervical adenocarcinoma (UEA). The cytological diagnosis falls short of a definitive diagnosis of GEA and is often categorized as atypical glandular cells (AGCs). To improve cytologic recognition, cytological findings of HPV-independent GEA were analyzed and the results compared with HPV-associated UEA.

METHODS: Cervical Papanicolaou (Pap) smears from eight patients with a histopathologic diagnosis of GEA and 12 control cases of UEA were reviewed. All slides were conventionally prepared and/or liquid-based prepared (ThinPrep) and stained following the Pap method. A mucinous background, architectural, nuclear, and cytoplasmic features were analyzed and compared with UEA.

RESULTS: Preoperative cytologic diagnoses of the eight GEA cases were AGCs, favor neoplastic in three cases, adenocarcinoma in situ in one case, and adenocarcinoma in four cases. Cytologically, monolayered honeycomb-like sheets (p = .002) of atypical endocervical cells with vacuolar granular cytoplasm (p = .001) were extensive in GEA, and three-dimensional clusters (p = .010) were extensive in UEA. Although the differences were not statistically significant, background mucin (p = .058), vesicular nuclei (p = .057), and golden-brown intracytoplasmic mucin (p = .089) were also discriminatory findings for GEA versus UEA.

CONCLUSIONS: Although GEA is difficult to diagnose on cytologic screening, GEA can be recognized based on cytologic features of monolayered honeycomb sheets of atypical endocervical cells with abundant vacuolar cytoplasm and some golden-brown intracytoplasmic mucin. UEA cases are characterized by three-dimensional clusters.

PMID:36128862 | DOI:10.4132/jptm.2022.07.05

Orthop Surg. 2022 Sep 21. doi: 10.1111/os.13499. Online ahead of print.

ABSTRACT

OBJECTIVE: Soft tissue sarcomas (STSs) arising from the popliteal fossa pose surgical challenges due to their proximity to critical neurovascular structures. This study aimed to investigate whether a novel 3D imaging technique highlighting these key anatomical structures could facilitate preoperative planning and improve surgical outcomes in STS.

METHODS: This was a prospective, observational, pilot study. Between November 2019 and December 2020, 27 patients with STS of the popliteal fossa undergoing limb-sparing procedures were enrolled and assigned to either a control or intervention group. Control patients underwent traditional preoperative planning with separate computed tomography angiography, magnetic resonance imaging, and magnetic resonance hydrography. In the intervention group, 3D images were generated from these images, the tumor and skeletomuscular and neurovascular structures were revealed in three dimensions, and this was visualized on the surgeon’s smartphone or computer. Primary endpoints were surgical margins and complications. Secondary endpoints included operative time, blood loss, serum C-reactive protein and interleukin-6, length of in-hospital stay, and limb function. Comparisons between groups were made using independent-sample t-tests for continuous data and the Mann-Whitney U and Fisher’s exact tests for categorical data.

RESULTS: There was a lower but not significantly different inadvertent positive margin rate (1/15 vs. 3/12, P = 0.294), significantly shorter hospital stay (P = 0.049), and less numbers ≥75th percentile of operative time (P = 0.037) and blood loss (P = 0.024) in the intervention group. Differences in surgical complications, operative time, blood loss, C-reactive protein and interleukin-6 levels on the second postoperative day, and limb functional scores were statistically insignificant.

CONCLUSIONS: The novel 3D imaging technique facilitates complex preoperative planning and limb-salvage surgical procedures for patients with STS of the popliteal fossa, and this may affect how surgical planning is performed in the future.

PMID:36128857 | DOI:10.1111/os.13499

Thyroid. 2022 Sep 21. doi: 10.1089/thy.2022.0280. Online ahead of print.

ABSTRACT

BACKGROUND: The most prevalent extrathyroidal manifestation of Graves’ disease (GD) is Graves’ ophthalmopathy (GO). However, only few methods allow for predictions of GO occurrence or progression in patients with GD.

METHODS: We retrospectively analyzed 1,074 patients with new-onset GD, and divided them into a derivation and a validation cohort based on the date of their GD diagnosis. We then separately analyzed clinical risk factors affecting the occurrence and progression of GO using multivariable regression analysis and created a predictive model based on the factors we identified as significant.

RESULTS: Of the 853 GD patients included in the derivation cohort, 101 (11.8%) developed GO. Those who developed GO were more likely to be smokers (25.7% vs. 8.5%, P < 0.001), were younger at the time of their GD diagnosis (35.0 years vs. 42.0 years, P < 0.001), more commonly had a family history of GD (27.7% vs. 17.2%, P = 0.015), and had higher thyrotropin-binding inhibitor immunoglobulin (TBII) levels at the time of their diagnosis (13.5 IU/L vs. 10.0 IU/L, P = 0.020) than those who did not develop GO. Of the 101 GO patients in the derivation cohort, after excluding eight who initially had active and moderate-to-severe GO, 11 of the remaining 93 had progressed to more active or severe GO. GO patients with confirmed progression had a higher proportion of those older than 45 years (54.5% vs. 19.8%, P = 0.031), and they had a different initial CAS distribution. The multivariable regression analysis identified age at GD diagnosis, sex, smoking history, family history of GD, total cholesterol level, and TBII level at the time of the diagnosis as significant risk factors of GO occurrence, and a predictive model including these risk factors was built to create a nomogram.

CONCLUSIONS: The predictors of GO occurrence in patients with new-onset GD were female sex, positive smoking history, young age, family history of GD, high cholesterol level, and high TBII level. The predictive nomogram developed in this study may be useful in patient counseling and facilitating informed treatment decision-making.

PMID:36128837 | DOI:10.1089/thy.2022.0280

Stat Methods Med Res. 2022 Sep 21:9622802221125912. doi: 10.1177/09622802221125912. Online ahead of print.

ABSTRACT

The median is a robust summary commonly used for comparison between populations. The existing literature falls short in testing for equality of survival medians when the collected data do not form representative samples from their respective target populations and are subject to right censoring. Such data commonly occur in prevalent cohort studies with follow-up. We consider a particular case where the disease under study is stable, that is, the incidence rate of the disease is stable. It is known that survival data collected on diseased cases, when the disease under study is stable, form a length-biased sample from the target population. We fill the gap for the particular case of length-biased right-censored survival data by proposing a large-sample test using the nonparametric maximum likelihood estimator of the survivor function in the target population. The small sample performance of the proposed test statistic is studied via simulation. We apply the proposed method to test for differences in survival medians of Alzheimer’s disease and dementia groups using the survival data collected as part of the Canadian Study of Health and Aging.

PMID:36128831 | DOI:10.1177/09622802221125912

Dent Med Probl. 2022 Sep 20. doi: 10.17219/dmp/149342. Online ahead of print.

ABSTRACT

BACKGROUND: The outbreak of the coronavirus disease 2019 (COVID-19) pandemic was associated with the provision of multiple guidelines for the dental profession. All elective procedures were restricted, and only emergency procedures were performed. There was fear and anxiety among dentists while performing aerosol-generating procedures (AGPs), as they were considered to pose a high risk of COVID-19 transmission.

OBJECTIVES: The aim of this study was to assess the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during AGPs, and to examine the association between risk severity and the number of AGPs performed per day. The efficacy of personal protective equipment (PPE) was also assessed.

MATERIAL AND METHODS: This cross-sectional cohort study was based on an online questionnaire form completed by 629 general and specialized dentists between January 1 and February 28, 2021. The collected data referred to the sources of COVID-19 infection, the type of PPE used and the number of AGPs performed each day by dental healthcare professionals (DHCPs). For each question, the absolute numbers of responses as well as percentages were calculated.

RESULTS: Among the 629 DHCPs, 113 (17.97%) contracted COVID-19. The risk of contracting COVID-19 during AGPs was the same as in the case of non-AGPs, and the infection risk was not associated with the number of AGPs performed per day. The efficacy of a surgical mask with a face shield/eye goggles was higher in comparison with all other types of PPE. Differences in the infection risk across the different types of PPE used were statistically significant (p < 0.001).

CONCLUSIONS: The risk of COVID-19 transmission during AGPs is the same as in the case of non-AGPs. Thus, restrictions on the performance of elective AGPs should be lifted. On the other hand, the best protection during AGPs is provided by a surgical mask with a face shield/eye goggles.

PMID:36128802 | DOI:10.17219/dmp/149342

J Am Geriatr Soc. 2022 Sep 21. doi: 10.1111/jgs.18042. Online ahead of print.

ABSTRACT

BACKGROUND: The longitudinal associations of sleep timing and time in bed (TIB) with dementia and cognitive decline in older adults are unclear.

METHODS: This population-based cohort study used data from 1982 participants who were aged ≥60 years, free of dementia, and living in rural communities in western Shandong, China. At the baseline (2014) and follow-up (2018) examinations, sleep parameters were assessed using standard questionnaires. Cognitive function was measured using the Mini-Mental State Examination (MMSE). Dementia was diagnosed following the DSM-IV criteria, and the NIA-AA criteria for Alzheimer disease (AD). Data were analyzed using restricted cubic splines, Cox proportional-hazards models, and general linear models.

RESULTS: During the mean follow-up of 3.7 years, dementia was diagnosed in 97 participants (68 with AD). Restricted cubic spline curves showed J-shaped associations of sleep duration, TIB, and rise time with dementia risk, and a reverse J-shaped association with mid-sleep time. When sleep parameters were categorized into tertiles, the multivariable-adjusted hazard ratio (HR) of incident dementia was 1.69 (95%CI 1.01-2.83) for baseline sleep duration >8 hours (vs. 7-8 h), 2.17 (1.22-3.87) for bedtime before 9 p.m. (vs. 10 p.m. or later), and 2.00 (1.23-3.24) for mid-sleep time before 1 a.m. (vs. 1-1.5 a.m.). Early bedtime and mid-sleep time were significantly associated with incident AD (HR range: 2.25-2.51; p < 0.05). Among individuals who were free of dementia at follow-up, baseline long TIB, early bedtime and mid-sleep time, early and late rise time, and prolonged TIB and advanced bedtime and mid-sleep time from baseline to follow-up were associated with a greater decline in MMSE score (p < 0.05). These associations with cognitive decline were statistically evident mainly among men or participants who were aged 60-74 years.

CONCLUSIONS: Long TIB and early sleep timing are associated with an increased risk of dementia, and the associations with greater cognitive decline are evident only among older people aged 60-74 years and men.

PMID:36128778 | DOI:10.1111/jgs.18042

J Thromb Haemost. 2022 Sep 21. doi: 10.1111/jth.15890. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, many important advances have been seen in anticoagulation therapy. However, bleeding risk is still a major concern. Factor XI inhibition has emerged as a potential advantageous target to minimize this risk.

OBJECTIVES: We conducted a systematic review and meta-analysis of current evidence on factor XI inhibitors for thromboprophylaxis in major orthopedic surgery.

METHODS: We performed a systematic search of electronic databases (Pubmed, CENTRAL, and Scopus) until May of 2022. Studies were considered eligible if they were RCTs evaluating factor XI inhibitors in thromboprophylaxis vs. low-molecular-weight heparins (LMWH). For analysis purposes, we considered efficacy (Venous Thromboembolism [VTE], symptomatic VTE) and safety (major and clinically relevant non-major [CRNM] bleeding events; major bleeding events; blood transfusion necessities; adverse events; major adverse events) outcomes.

RESULTS: Overall, 4 RCTs were included, with a total of 2269 patients, 372 VTE events, and 50 major or CRNM bleeding events. Regarding efficacy outcomes, factor XI inhibitors were associated with a significant reduction in the incidence of VTE events (OR 0.50; 95%CI [0.36, 0.69]). Concerning safety outcomes, factor XI inhibitors significantly reduced major or CRNM bleeding events (OR 0.41 [0.22; 0.75]). It was also associated with a lower percentage of patients needing a blood transfusion, despite not meeting statistical significance (OR 0.69; 95%CI [0.32; 1.48]). Incidence of adverse events and major adverse events were similar between groups.

CONCLUSION: Factor XI inhibitors showed a significant reduction in the incidence of VTE and bleeding events among patients submitted to major orthopedic surgery.

PMID:36128769 | DOI:10.1111/jth.15890

West Afr J Med. 2022 Sep 16;39(9):958-963.

ABSTRACT

BACKGROUND: Information on the causes and outcome of treatment of vitreous hemorrhage (VH) in sub-Saharan Africa is limited.

OBJECTIVES: To determine the causes and postoperative vision after vitrectomy for VH.

DESIGN: A retrospective review of records from consecutive eyes, with VH greater than one-month duration, who had vitrectomy and adjunctive treatment in a retina unit in Nigeria.

METHODS: We assessed the change between preoperative and postoperative visual acuity, bio data, cause of VH, duration of follow up, and additional treatment. Data was analyzed using SPSS statistical package 17.0 to determine the significance of the change in visual acuity for each cause of VH. A p value <0.05 was considered statistically significant.

RESULTS: Of the 221 eyes of 219 patients, the common causes of VH were trauma 43 eyes, (19.7%), proliferative diabetic retinopathy, 37 eyes (17.0%) and proliferative sickle cell retinopathy, 30 eyes (13.8%). There was no association between cause and the presenting preoperative visual acuity. There was a statistically significant association between cause of VH and postoperative visual outcome. Postoperative visual improvement was significant for branch retinal vein occlusion, central retinal vein occlusion, proliferative diabetic retinopathy with VH only, proliferative sickle cell retinopathy, and trauma with VH only, p value = 0.000, 0.002, 0.001, 0.039, and 0.000 respectively. Postoperative visual change was not significant in age-related macular degeneration and polypoidal choroidal vasculopathy (p value = 0.155, 0.428 respectively).

CONCLUSION: Significant improvements in visual acuity can be achieved with active treatment of VH in the majority of cases in Nigeria. This information is useful for discussions on prognosis and agrees with previous studies.

PMID:36128750