Nevin Manimala

Patient Educ Couns. 2022 Jul 16:S0738-3991(22)00333-0. doi: 10.1016/j.pec.2022.07.009. Online ahead of print.

ABSTRACT

BACKGROUND: Promoting interconception health can improve birth outcomes and long-term women’s health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement.

OBJECTIVE: This scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions.

METHODS: We searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features.

RESULTS: There were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes.

DISCUSSION: MI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion.

PRACTICAL VALUE: MI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.

PMID:35870992 | DOI:10.1016/j.pec.2022.07.009

Orphanet J Rare Dis. 2022 Jul 23;17(1):288. doi: 10.1186/s13023-022-02443-1.

ABSTRACT

PURPOSE: To explore the relationship between the genotype and renal phenotype in a Chinese cohort and guide clinical decision-making for treating tuberous sclerosis complex (TSC).

MATERIALS AND METHODS: We reviewed 173 patients with definite TSC at three centers in China from September 2014 to September 2020. All the patients underwent TSC1 and TSC2 genetic testing as well as renal phenotypic evaluation. All analyses were performed using the SPSS software, version 19.0, with a cut-off P value of 0.05 considered statistically significant.

RESULTS: We identified variants in 93% (161/173) cases, including 16% TSC1 and 77% TSC2 variants. Analysis of the relationship between the genotype and renal phenotype, revealed that those with TSC2 variants were more likely to develop severe renal AML (> 4) (P = 0.044). In terms of treatment, TSC2 variants were more likely to undergo nephrectomy/partial nephrectomy (P = 0.036) and receive mTOR medication such as everolimus (P < 0.001). However, there was no significant difference between the two groups in terms of their response to the everolimus treatment.

CONCLUSION: Patients with TSC2 variants exhibit more severe renal phenotypes, especially those associated with renal angiomyolipomas (AML), and they often require nephrectomy/partial nephrectomy or mTOR medication. Detection of the genotype is helpful in TSC management.

PMID:35870981 | DOI:10.1186/s13023-022-02443-1

J Clin Lab Anal. 2022 Jul 23:e24618. doi: 10.1002/jcla.24618. Online ahead of print.

ABSTRACT

BACKGROUND: Analytical evaluation of newly developed presepsin by a Sysmex HISCL-5000 (Sysmex, Japan) automated immune analyzer was performed.

METHODS: For evaluation, sepsis patient samples were collected before treatment in an emergency department. Precision, linearity, limit of blank/limit of detection, method comparisons, and reference intervals were evaluated. Method comparisons were performed using a PATHFAST immune analyzer (LSI Medience Corporation, Japan).

RESULTS: Precision using a 20x2x2 protocol for low (306 pg/mL) and high (1031 pg/mL) levels resulted in within-laboratory standard deviation (95% confidence interval [CI]) and coefficient of variation (CV) %, which were as follows: 15.3 (13.1-18.7), 5.5% and 47.7, (40.5-58.1), 6.4%, respectively. Linearity using patient samples and calibrators were measured from 201 to 16,177 and 188 to 30,000 pg/mL, respectively. The regression equation was y = -23.2 + 1.008x (SE = 162.4) for low levels and y = 779.9 + 1.006x (SE = 668) for high levels. Method comparison by Passing-Bablock analysis was as follows: y = -209.77 + 1.047x (S_yx = 335.3). The correlation coefficient (95% CI) was 0.869 (0.772-0.927) with statistical significance (p < 0.001). Reference intervals from 120 normal healthy subjects showed that 300 pg/mL was the cut off. Presepsin tended to show a higher value at higher ages and in males. Presepsin showed correlation with some parameters, and the correlation coefficient (p value) were as follows: hematocrit, 0.198 (0.03); eGFR (CKD-EPI), -0.240 (0.0129); MDRD-eGFR, -0.194 (0.048), respectively.

CONCLUSION: Presepsin measurement by HISCL-5000 showed reliable performance. Further clinical studies are required for the diagnosis and prognosis of sepsis.

PMID:35870180 | DOI:10.1002/jcla.24618

J Card Surg. 2022 Jul 23. doi: 10.1111/jocs.16800. Online ahead of print.

ABSTRACT

INTRODUCTION: Aortic valve neocuspidization (AVNeo) for trileaflet aortic valve reconstruction using autologous pericardium (Ozaki procedure) depicts an encouraging new technique for the surgical treatment of aortic valve pathologies. The current study analyzes the early hemodynamic outcome of AVneo compared with surgical aortic valve replacement (SAVR) using the Abbott/St. Jude Trifecta aortic valve biological prostheses.

METHODS: All patients who underwent either AVNeo or SAVR between March 2017 and April 2020 were included. Exclusion criteria were emergency cases, endocarditis, redo- or additional root procedures. Main endpoints were differences between the two groups in terms of the effective orifice area (EOA) and the effective orifice area index (EOAI) at discharge.

RESULTS: During the study period, 105 AVNeo patients and 458 SAVR patients met the inclusion criteria. EOA was significantly higher in the AVNeo group (2.4 cm² ± 0.8 vs. 2.1 cm² /m² ± 0.6 in the SAVR group, respectively; p < .001). Multiple regression analysis, including AVNeo, annulus size, bicuspid valve, preoperative stenosis, left ventricular ejection fraction (LVEF), and diastolic diameter (LVEDD) found two factors, which favor larger EOA: Annulus size (p < .0001) and AVneo (p = .005). EOAI was significantly higher in the AVNeo group (1.23 ± 0.4 vs. 1.02 cm² /m² ± 0.3, respectively; p < .001). Multiple regression analysis for EOAI showed effects for AVneo (p = .005) and bicuspid valve (p = .029). Mean pressure gradients (MPG) were lower in the AVNeo group than in the SAVR group (AVNeo: MPG = 8.0 mmHg ± 3.6 vs. SAVR: MPG = 8.3 mmHg ± 3.6), but this finding did not reach statistical significance (p = .091).

CONCLUSIONS: AVNeo shows significantly larger EOA and EOAI compared to SAVR using the Abbott/St. Jude Trifecta aortic valve biological prostheses.

PMID:35870166 | DOI:10.1111/jocs.16800

J Eur Acad Dermatol Venereol. 2022 Jul 23. doi: 10.1111/jdv.18459. Online ahead of print.

ABSTRACT

BACKGROUND: Epidemiological studies have suggested psoriasis was associated with an increased risk of Parkinson’s disease (PD). However, whether psoriasis has an effect on PD progression is not explored yet.

OBJECTIVES: To evaluate the causal role of psoriasis in PD progression.

METHODS: We conducted a two-sample Mendelian randomization analysis using summary statistics from genome-wide association study of psoriasis (N=33,394), age at onset (N=28,568) and progression (N=4,093) of PD.

RESULTS: One standard deviation increase in genetically determined psoriasis risk was significantly associated with faster progression to dementia (OR=1.07, 95 % CI: 0.1.03~1.1, P=4.71E-04). Meanwhile, higher psoriasis risk was nominally associated with faster progression of PD measured by time to Hoehn and Yahr stage 3 (OR=1.05, 95 % CI: 1.02~1.08, P=1.53E-03) and depression (OR=1.06, 95 % CI: 1.02~1.11, P=1.77E-03) of PD. The results were robust under all sensitivity analyses.

CONCLUSIONS: These results suggested psoriasis accelerated overall progression of PD, and increased risk of dementia and depression of PD. A deeper understanding of neuroinflammation and immune response is likely to elucidate the potential pathogenesis of PD progression and identify novel therapeutic targets.

PMID:35870136 | DOI:10.1111/jdv.18459

J Eur Acad Dermatol Venereol. 2022 Jul 23. doi: 10.1111/jdv.18456. Online ahead of print.

ABSTRACT

BACKGROUND: Electrochemotherapy (ECT) effectively controls skin metastases from cutaneous melanoma.

OBJECTIVES: This study aimed to evaluate health-related quality of life (HRQoL) in melanoma patients pre-/post-ECT and its effect on treatment outcome.

METHODS: The analysis included prospective data from the International Network for Sharing Practices of ECT register. Following the Standard Operating Procedures, patients received intravenous or intratumoural bleomycin (15,000 IU/m² ; 1000 IU mL/cm³ ) followed by 100-microsecond, 1000-V/cm electric pulses. Endpoints included response (RECIST v3.0), local progression-free survival (LPFS), toxicity (CTCAE v5.0), and patient-reported HRQoL at baseline, one, two, four and ten months (EuroQol [EQ-5D-3L], including 5-item utility score [EQ-5D] and visual analogue scale for self-reported health state [EQ-VAS]). Comparisons within/between subgroups were made for statistical and minimal important differences (MID). HRQoL scores and clinical covariates were analysed to identify predictors of response in multivariate analysis.

RESULTS: Median tumour size was 2 cm. Complete response rate, G3 toxicity and one-year LPFS in 378 patients (76% of the melanoma cohort) were 47%, 5%, and 78%. At baseline, age-paired HRQoL did not differ from the general European population. Following ECT, both EQ-5D and EQ-VAS scores remained within MID boundaries, particularly among complete responders. A subanalysis of the EQ-5D items revealed a statistically significant deterioration in pain/discomfort and mobility (restored within four months), and self-care and usual activities (throughout the follow-up) domains. Concomitant checkpoint inhibition correlated with better EQ-5D and EQ-VAS trajectories. Baseline EQ-5D was the exclusive independent predictor for complete response (RR 14.76, p=0.001).

CONCLUSIONS: HRQoL of ECT melanoma patients parallels the general population and is preserved in complete responders. Transient deterioration in pain/discomfort and mobility and persistent decline in self-care and usual activities may warrant targeted support interventions. Combination with checkpoint inhibitors is associated with better QoL outcomes. Baseline HRQoL provides predictive information which can help identify patients most likely to respond.

PMID:35870122 | DOI:10.1111/jdv.18456

Sports Med. 2022 Jul 23. doi: 10.1007/s40279-022-01737-5. Online ahead of print.

NO ABSTRACT

PMID:35870107 | DOI:10.1007/s40279-022-01737-5

J Assist Reprod Genet. 2022 Jul 23. doi: 10.1007/s10815-022-02567-0. Online ahead of print.

ABSTRACT

PURPOSE: The field of oncofertility has maintained an important focus on improving access, yet standardized practices are lacking. To assess how female cancer patients are provided oncofertility care, we sought to determine provider-level differences and whether there are physician or practice characteristics that predict these variations.

METHODS: A cross-sectional survey was sent to SREI members. The survey included fifteen questions about physician practice characteristics and oncofertility cryopreservation protocols. Topics included ovarian stimulation protocols, fertilization techniques, stage of embryo cryopreservation, routine use of pre-implantation genetic testing for aneuploidy (PGT-A), and ovarian tissue cryopreservation (OTC). Statistical analyses assessed whether practice setting, geographic region, time in practice, and mandatory state insurance coverage had effects on cryopreservation protocols.

RESULTS: A total of 141 (17%) from diverse REI practice backgrounds completed the survey. The median number of new female oncofertility consults per year was 30 (range 1 to 300). Providers in academic settings treated more patients (median 40 vs. 15, p < 0.001). Providers in academic settings more often use gonadotropin-releasing hormone agonists (85% vs. 52%, p < 0.001) and perform OTC (41% vs. 4%, p < 0.001). Providers in academic practices were less likely to perform intracytoplasmic sperm injection in every cycle (37% vs. 55%, p = 0.032) and less likely to usually advise PGT-A (21% vs. 36%, p = 0.001). Mandated state insurance coverage had no effect on oncofertility practices.

CONCLUSION: Oncofertility practices vary among providers. Factors such as practice setting and region may affect the services provided. We do not yet know the best practices in oncofertility patients, and future research is needed.

PMID:35870098 | DOI:10.1007/s10815-022-02567-0

Cerebellum. 2022 Jul 23. doi: 10.1007/s12311-022-01449-6. Online ahead of print.

ABSTRACT

The aim of this study was to explore the association between sex and cerebellar mutism syndrome and to examine other potential risk factors. This ambispective cohort study examined 218 pediatric patients (132 boys) with a posterior fossa tumor who underwent tumor resection from July 2013 to March 2021. The patients’ demographics and tumor characteristics were examined and statistically analyzed to explore the associations among the variables. Multivariable and subgroup analyses were conducted to validate the independent risk factors for cerebellar mutism syndrome (CMS). The male and female patients did not differ significantly in terms of age, tumor size, tumor location, tumor consistency, VP shunt placement before resection, extent of resection, or surgeon, as well as with respect to the presence of hydrocephalus or paraventricular edema. The overall incidence of CMS was 32.6%. The incidence of CMS was significantly higher in male patients than that in female patients (41.7% vs. 18.6%; P = 0.001). In the multivariable analysis, male sex (adjusted odds ratio [OR], 3.27; P = 0.001), solid tumor consistency (adjusted OR, 5.61; P = 0.001), midline location (adjusted OR, 3.78; P = 0.004), and hydrocephalus (adjusted OR, 2.56; P = 0.047) were independent risk factors for the CMS. Chi-square analysis revealed that solid tumor consistency and midline location were associated with medulloblastoma (P < 0.001). Male patients had a higher risk of developing CMS after a posterior fossa tumor resection. Midline location, solid tumor consistency, and hydrocephalus were independent risk factors for CMS.

PMID:35870083 | DOI:10.1007/s12311-022-01449-6

Int Ophthalmol. 2022 Jul 23. doi: 10.1007/s10792-022-02427-x. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS).

METHODS: This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts.

RESULTS: In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (-2.2 ± 3.4 mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6 months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6 months.

CONCLUSION: Both FLACS and CPS resulted in similar and significant IOP reductions through 6 months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.

PMID:35870049 | DOI:10.1007/s10792-022-02427-x