Nevin Manimala

Ann Surg Oncol. 2022 May 2. doi: 10.1245/s10434-022-11758-z. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive inguinal lymphadenectomy (MILND) is safe and feasible, but limited data exist regarding oncologic outcomes.

METHODS: This study performed a multi-institutional retrospective cohort analysis of consecutive MILND performed for melanoma between January 2009 and June 2016. The open ILND (OILND) comparative cohort comprised patients enrolled in the second Multicenter Selective Lymphadenectomy Trial (MSLT-II) between December 2004 and March 2014.The pre-defined primary end point was the same-basin regional nodal recurrence, calculated using properties of binomial distribution. Time to events was calculated using the Kaplan-Meier method. The secondary end points were overall survival, progression-free survival, melanoma-specific survival (MSS), and distant metastasis-free survival (DMFS).

RESULTS: For all the patients undergoing MILND, the same-basin regional recurrence rate was 4.4 % (10/228; 95 % confidence interval [CI], 2.1-7.9 %): 8.2 % (4/49) for clinical nodal disease and 3.4 % (6/179) for patients with a positive sentinel lymph node (SLN) as the indication. For the 288 patients enrolled in MSLT-II who underwent OILND for a positive SLN, 17 (5.9 %) had regional node recurrence as their first event. After controlling for ulceration, positive LN count and positive non-SLNs at the time of lymphadenectomy, no difference in OS, PFS, MSS or DMFS was observed for patients with a positive SLN who underwent MILND versus OILND.

CONCLUSION: This large multi-institutional experience supports the oncologic safety of MILND for melanoma. The outcomes in this large multi-institutional experience of MILND compared favorably with those for an OILND population during similar periods, supporting the oncologic safety of MILND for melanoma.

PMID:35499783 | DOI:10.1245/s10434-022-11758-z

Arch Womens Ment Health. 2022 May 2. doi: 10.1007/s00737-022-01230-y. Online ahead of print.

ABSTRACT

Rapid screening tools are useful for identifying at-risk patients and referring them for further assessment and treatment, but none exist that consider the unique medical needs of pregnant women with eating disorders (EDs). There is a need for a rapid, sensitive, and specific screening tool that can be used to identify a potential ED in pregnancy. We started with a set of 25 questions, developed from our qualitative work along with other ED screening tools, and tested on a development (n = 190) and validation sample (n = 167). Statistical analysis included factor analysis and logistic regressions with ROC curves. Development and validation samples were combined for trimester analysis (n = 357). Refining the tool to 12 items demonstrated strong internal reliability (development alpha = 0.95, validation alpha = 0.91). With correlated errors, questions demonstrated acceptable CFA fit (development: GFI: 0.91, RMSEA: 0.10, NNFI: 0.95; validation: GFI: 0.85, RMSEA: 0.14, NNFI: 0.86). Similar fits were seen by trimester: first trimester n = 127, GFI: 0.89, RMSEA: 0.12, NNFI: 0.94; second trimester n = 150, GFI: 0.83, RMSEA: 0.14, NNFI: 0.88; third trimester n = 80, GFI: 0.99, NNFI: 0.99. Validation against current ED diagnosis demonstrated acceptable sensitivity and specificity using a cutoff of 39 (development sensitivity = 80.7%, specificity = 79.7%, OR = 16.42, 95% CI: 7.51, 35.88; validation sensitivity = 69.2%, specificity = 86.5%, OR: 17.43, 95% CI: 6.46, 47.01). Findings suggest the PEBS tool can reliably and sensitively detect EDs across pregnancy trimesters with 12 questions. A further implication of this work is to reduce health and mental health treatment disparities through this standard and rapid screening measure to ensure early identification and treatment.

PMID:35499780 | DOI:10.1007/s00737-022-01230-y

Arch Orthop Trauma Surg. 2022 May 2. doi: 10.1007/s00402-022-04450-0. Online ahead of print.

ABSTRACT

BACKGROUND: Use of multimodal analgesia (MMA) prior to orthopedic surgery has been adopted by many practitioners as a strategy to minimize use of opioid medications. The purpose of this investigation was to quantify the effect of a preemptive three-drug regimen (acetaminophen, celecoxib, and gabapentin) in terms of post-operative opioid consumption and pain control in the field of total joint arthroplasty.

METHODS: A retrospective chart review was conducted on 1691 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and stratified by whether they received a preemptive three medication analgesic therapy (acetaminophen, celecoxib, and gabapentin) within 30 to 60 min prior to entering the operating room. Post-operative opioid consumption as well as subjectively reported patient pain scores were assessed throughout their hospital stay.

RESULTS: A total of 1416 eligible patients were identified with 485 undergoing THA and 931 undergoing TKA. Statistically significant reductions in oral morphine equivalents were shown on post-operative day zero and two within the TKA cohort, and non-significant reductions were demonstrated in other intervals for both procedure types. Statistically significant reductions in patient reported pain scores were shown in nearly every time interval in both procedure types.

CONCLUSION: The receipt of preemptive acetaminophen, celecoxib, and gabapentin 30-60 min prior to total joint arthroplasty demonstrated modest reductions in opioid requirements post-operatively. Patients receiving preemptive MMA reported lower pain scores throughout nearly every time interval during their admission after surgery. Further investigations are warranted regarding optimal preoperative medication therapies to promote adequate post-operative pain control-and ultimately diminished opioid consumption-in the setting of total joint arthroplasty.

PMID:35499774 | DOI:10.1007/s00402-022-04450-0

Clin Rheumatol. 2022 May 2. doi: 10.1007/s10067-022-06167-2. Online ahead of print.

ABSTRACT

Homelessness is a public health crisis and there is a paucity of information about patients with rheumatic disease experiencing homelessness. We sought to develop approaches to improve care for this unique patient population. We previously reported observations on 17 homeless patients with inflammatory arthritis (15 rheumatoid arthritis (RA), 2 psoriatic arthritis (PsA)). We obtained follow-up information from our original 17 patients and compared this to data summarized and published about them from 12 months previously. We also created and administered a 100-question needs assessment survey. Follow-up 12-month clinical information was available from 13/17 homeless and 13/17 non-homeless controls. Homeless patients remained less well with more disease than non-homeless patients-poorer access to clinic appointments (80% vs 91%, p < 0.05), more emergency services use (20 vs 5 ED visits), less DMARDs use (43% vs 100%, p < 0.01), and more steroid use (29% vs 0%, p < 0.01). Homeless patients also had higher inflammatory markers than non-homeless patients (ESR 32 vs 26 mm/h and CRP 17 vs 5 mg/L), although these findings were not statistically significantly different. Seventy-eight percent of homeless patients were stable, 14% improved, and 7% worse; 21% had stable controlled and 57% stable active disease vs 62% and 0% of non-homeless (p < 0.01). Among the homeless, 6 (4 RA, 2 PsA) completed the survey, 2 declined, and 9 could not be reached. All 6 had found housing although all still had housing insecurity; 4 (67%) were homeless in the past. Three out of six (50%) obtained housing from social assistance during hospitalization following disease exacerbation while homeless. The average monthly income was $873. 5/6 (83.3%), were unable to work due to health, and were in considerable pain that adversely impacted their physical and mental health and ability to perform ADLs. Their perceived “greatest need” included dental care, physical therapy, knee surgery, employment, socialization secondary to isolation, and stable housing. Our understanding of the unique challenges of patients with rheumatic disease experiencing homelessness is improved, but not complete. Strengthened collaboration between street medicine providers and rheumatologists is necessary to improve care for homeless patients, especially given poorer outcomes compared with non-homeless counterparts. Key Points • We report 12-month follow-up information from our original 17 homeless patients with inflammatory arthritis (related in this journal in 2021) and their responses to an extensive needs assessment survey designed to identify barriers to care. • Homeless patients with inflammatory arthritis continued to have worse disease outcomes, use more corticosteroids and less DMARDs, and be seen less often in rheumatology clinics and more frequently in emergency departments than their non-homeless counterparts. • Survey data indicated that social assistance during hospitalization was a key area where healthcare providers could intervene to provide housing security for homeless patients and improve outcomes. Patients perceived “greatest needs” went beyond housing and rheumatological care and critically included access to social/specialty services. • Street medicine is the direct delivery of healthcare to people experiencing homelessness wherever they reside. Our observations, obtained in collaboration with street medicine colleagues, suggest important and salutary opportunities for this partnership to improve care for these particular patients.

PMID:35499771 | DOI:10.1007/s10067-022-06167-2

Environ Sci Pollut Res Int. 2022 Apr 30. doi: 10.1007/s11356-022-19761-3. Online ahead of print.

ABSTRACT

Rapid urbanisation has had a significant negative influence on the water bodies that flow through and around urban areas. This study aims to evaluate the water quality and analyse the suitability for drinking and irrigation uses. This study envisaged assessing the water quality status of the groundwater using the pollution index of groundwater (PIG), ecological risk index (ERI) and multivariate statistical techniques, namely cluster analysis (CA) and principal component analysis (PCA), that were applied to differentiate the sources of water quality variation and determine the cause of pollution in the study area. Most groundwater is unsuitable for drinking and irrigation consumption, depending on analyses. PIG values indicated high pollution levels in the studied water body, rendering it unsuitable for any practical purpose. CA results showed the impact of surface water and treatment plant on groundwater. PCA was used to identify four important factors in the groundwater, including mineral and nutrient pollution, heavy metal pollution, organic pollution and faecal contamination. The deteriorating water quality of the groundwater was demonstrated to originate from vast sources of anthropogenic activities, especially municipal sewage discharge. Study wells had greater concentrations of Cl^– and Na⁺ in their water because seawater flows into the aquifer system and mixes with the marine aquifer matrix. Thus, the current work reveals how to employ the PIG and multivariate statistical approaches to obtain more accessible and more meaningful information about the water quality of groundwater and to identify the sources of pollution.

PMID:35499738 | DOI:10.1007/s11356-022-19761-3

Environ Sci Pollut Res Int. 2022 Apr 30. doi: 10.1007/s11356-022-20362-3. Online ahead of print.

ABSTRACT

Over the period 1980-2016, this study looks into the causal relations between carbon dioxide (CO₂) emissions, energy consumption (EC), foreign direct investment (FDI), and gross domestic product (GDP) in five South Asian countries (Bangladesh, India, Nepal, Pakistan, and Sri Lanka). To achieve the research objectives, panel unit root tests, panel co-integration, autoregressive distributed lag model, and Granger causality tests are used. In the long run, GDP has a positive impact on CO₂ emissions, while squared GDP has a negative impact, confirming the framework of the environmental Kuznets curve (EKC) in Pakistan and Sri Lanka. However, in the short run along with these two countries, Bangladesh also confirms the EKC hypothesis. Among these five countries, Bangladesh and Nepal support the pollution haven hypothesis, but India, Pakistan, and Sri Lanka support the FDI halo hypothesis. The EC has a large positive impact on CO₂ emissions across five countries. In the long run, the Granger causality test confirms one-way causation from EC to CO₂ emissions and bidirectional causality of FDI and CO₂. These countries might encourage clean energy technology through FDI without jeopardizing GDP and environmental quality. The findings of the study provide a guideline for these countries to reduce CO₂ emissions, achieve a long-term green GDP, and combat global warming.

PMID:35499737 | DOI:10.1007/s11356-022-20362-3

J Math Biol. 2022 May 2;84(6):46. doi: 10.1007/s00285-022-01756-w.

ABSTRACT

This paper deals with a system of reaction-diffusion-advection equations for a generalist predator-prey model in open advective environments, subject to an unidirectional flow. In contrast to the specialist predator-prey model, the dynamics of this system is more complex. It turns out that there exist some critical advection rates and predation rates, which classify the global dynamics of the generalist predator-prey system into three or four scenarios: (1) coexistence; (2) persistence of prey only; (3) persistence of predators only; and (4) extinction of both species. Moreover, the results reveal significant differences between the specialist predator-prey system and the generalist predator-prey system, including the evolution of the critical predation rates with respect to the ratio of the flow speeds; the take-over of the generalist predator; and the reduction in parameter range for the persistence of prey species alone. These findings may have important biological implications on the invasion of generalist predators in open advective environments.

PMID:35499718 | DOI:10.1007/s00285-022-01756-w

Appl Biochem Biotechnol. 2022 May 2. doi: 10.1007/s12010-022-03945-1. Online ahead of print.

ABSTRACT

Batch experiments were performed to evaluate the biohydrogen and biomethane production by co-digestion of chicken manure and food waste in a two-stage mesophilic fermentation process. Results showed that no hydrogen was produced in the first stage of sole chicken manure fermentation, while methane yield was 247.3 mL·g^-1-VS. By comparison, the co-digestion process with food waste proportions of 50-85% obtained hydrogen yields of 15.5-57.5 mL·g^-1-VS, and the methane yields and maximum specific methane production rates were also improved by 7.0-16.7% and 80%, respectively. Moreover, the highest hydrogen and methane yields were achieved during sole food waste fermentation process. The acetate was the main volatile fatty acid (VFA) produced during sole chicken manure fermentation process in the first stage. Statistical analysis revealed that hydrogen production from co-digestion process and sole food waste fermentation process followed the n-butyrate-type pathway. Meanwhile, it should be noticed that the co-fermentation of chicken manure and food waste had antagonistic effects on the hydrogen fermentation, implying that there might be some inhibition factors existing in chicken manure or produced during the co-fermentation process. At the beginning of methane fermentation, the VFA profiles were similar to those at the end of hydrogen fermentation, and the main VFA compositions changed to acetate and propionate in the latter period of methane production. The volatile solid removal efficiencies were also promoted in co-digestion process compared with sole chicken manure digestion, which were increased by 9.7-14.4% with food waste proportions of 50-80%.

PMID:35499692 | DOI:10.1007/s12010-022-03945-1

Clin Oral Investig. 2022 May 2. doi: 10.1007/s00784-022-04514-w. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this randomized clinical trial (RCT) was to explore the clinical survival of a new, Bis-GMA-free pit and fissure sealant (Helioseal F Plus) in comparison to an established control material (Helioseal F).

MATERIAL AND METHODS: This in vivo study was designed as a prospective, 2-year, two-centre RCT with a split-mouth design. The initial study population consisted of 92 adolescents who were followed up 1 month (N = 89), 6 months (N = 88), 1 year (N = 85) and 2 years (N = 82) after sealant application. The attrition rate was 10.9% after 2 years. At each examination, the sealant retention and presence of caries were recorded. The statistical analysis included the calculation of Kaplan-Meier survival curves, log-rank tests and a Cox proportional hazard regression model.

RESULTS: No adverse events during the application or any of the follow-up visits were documented. The proportion of completely intact sealants and those with minimal loss was almost identical in both groups at 85.9% (Helioseal F Plus) and 86.5% Helioseal F) after 2 years of observation. The regression analysis revealed operator dependency; no significant differences were found between the materials, the study centres, the chosen isolation technique and patient age or sex.

CONCLUSION: The newly developed sealant can be evaluated as at least equivalent in terms of survival and retention behaviour compared to the established control material.

CLINICAL RELEVANCE: The new sealant can be recommended for clinical use. With respect to the material properties (Bis-GMA-free, less light polymerisation time and better thixotropic behaviour), it offers additional advantages with clinical relevance.

PMID:35499655 | DOI:10.1007/s00784-022-04514-w

Mov Disord. 2022 May 2. doi: 10.1002/mds.29033. Online ahead of print.

ABSTRACT

BACKGROUND: Early diagnosis in patients with neurodegenerative disorders is crucial to initiate disease-modifying therapies at a time point where progressive neurodegeneration can still be modified.

OBJECTIVES: The objective of this study was to determine whether motor or non-motor signs of the disease occur as indicators of a prodromal phase of X-linked dystonia-parkinsonism (XDP), a highly-penetrant monogenic movement disorder with striking basal ganglia pathology.

METHODS: In addition to a comprehensive clinical assessment, sensor-based balance and gait analyses were performed in non-manifesting mutation carriers (NMCs), healthy controls (HCs), and patients with XDP. Gradient-boosted trees (GBT) methodology was utilized to classify groups of interest.

RESULTS: There were no clinically overt disease manifestations in the NMCs. Balance analysis, however, revealed a classification accuracy of 90% for the comparison of NMC versus HC. For the gait analysis, the best-performing GBT-based model showed a balanced accuracy of 95% (NMC vs. HC; walking at maximum speed). Using a separate analysis of genetic modifiers, several gait parameters correlated strongly with the estimated age at disease onset in the NMC group.

CONCLUSIONS: Our study unraveled balance and gait abnormalities in NMCs that preceded the onset of XDP. These findings demonstrate prodromal motor changes among NMCs who will develop XDP with a very high likelihood in the future. Gait abnormalities had a predictive value for the estimated age at onset highlighting the impact of genetic modifiers in personalized treatment in monogenic neurodegenerative disorders. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:35491955 | DOI:10.1002/mds.29033