Nevin Manimala

J Plast Reconstr Aesthet Surg. 2021 Mar 30:S1748-6815(21)00132-7. doi: 10.1016/j.bjps.2021.03.042. Online ahead of print.

ABSTRACT

BACKGROUND: There is a lack of consensus regarding the superiority of the common free flaps for the reconstruction of circumferential pharyngeal defects.

METHODS: A systematic literature search was conducted to identify studies reporting the complications of circumferential pharyngeal reconstruction between 2005 and 2020. Anterolateral thigh free flaps (ALTFF), jejunal free flaps (JFF), and radial forearm free flaps (RFFF) were compared. Various complications were compared by meta-analysis. Primary endpoints were fistula and stricture rates.

RESULTS: Forty studies were included (2230 patients). Stricture rate was similarly low with tubed ALTFF (13.3%, n = 36/270) and JFF (13.2%, n = 176/1334). Fistula rate was the lowest with JFF (9.2%, n = 58/634). ALTFF was associated with the lowest rates of partial and complete flap failure (3.8%, n = 6/157, and 2.8%, n = 5/178), infection (2.8%, n = 3/106), donor site morbidity (3.9%, n = 5/130), and mortality (0%, n = 0/101) within 30 days. A meta-analysis demonstrated that there was no statistically significant difference in stricture and fistula rates between ALTFF and JFF. Moreover, JFF was associated with a significantly lower fistula rate than that of RFFF (p < 0.001). ALTFF was associated with a significantly lower infection rate than that of JFF (p = 0.013).

CONCLUSIONS: The data suggest the use of ALTFF for circumferential pharyngeal defects. In the absence of randomized, prospective data, the authors hope the results presented can be used as an evidence-based reference.

PMID:33931325 | DOI:10.1016/j.bjps.2021.03.042

Clin Lung Cancer. 2021 Mar 27:S1525-7304(21)00069-3. doi: 10.1016/j.cllc.2021.03.015. Online ahead of print.

ABSTRACT

INTRODUCTION: We investigated whether adding computed tomography (CT) and/or ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET radiomics features to conventional prognostic factors (CPFs) improves prognostic value in locally advanced non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS: We retrospectively identified 39 cases with stage III NSCLC who received chemoradiotherapy and underwent planning CT and staging ¹⁸F-FDG PET scans. Seven CPFs were recorded. Feature selection was performed on 48 CT and 49 PET extracted radiomics features. A penalized multivariate Cox proportional hazards model was used to generate models for overall survival based on CPFs alone, CPFs with CT features, CPFs with PET features, and CPFs with CT and PET features. Linear predictors generated and categorized into 2 risk groups for which Kaplan-Meier survival curves were calculated. A log-rank test was performed to quantify the discrimination between the groups and calculated the Harrell’s C-index to quantify the discriminatory power. A likelihood ratio test was performed to determine whether adding CT and/or PET features to CPFs improved model performance.

RESULTS: All 4 models significantly discriminated between the 2 risk groups. The discriminatory power was significantly increased when CPFs were combined with PET features (C-index 0.82; likelihood ratio test P < .01) or with both CT and PET features (0.83; P < .01) compared with CPFs alone (0.68). There was no significant improvement when CPFs were combined with CT features (0.68).

CONCLUSION: Adding PET radiomics features to CPFs yielded a significant improvement in the prognostic value in locally advanced NSCLC; adding CT features did not.

PMID:33931316 | DOI:10.1016/j.cllc.2021.03.015

Parkinsonism Relat Disord. 2021 Apr 24:S1353-8020(21)00152-8. doi: 10.1016/j.parkreldis.2021.04.019. Online ahead of print.

ABSTRACT

BACKGROUND: Parkinson’s Disease (PD) is among one of the common comorbidities in older patients. People with PD may be more vulnerable to severe pneumonia, due to the impairment of pulmonary function. Currently, the association between PD and COVID-19 is not yet established. This study aims to analyze the relationship between PD and in-hospital outcomes of COVID-19.

MATERIALS AND METHODS: We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 25th, 2020. All articles published on COVID-19 and Parkinson’s Disease were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional studies. Statistical analysis was done using Review Manager 5.4 software.

RESULTS: A total of 12 studies with 103,874 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that Parkinson’s Disease was associated with poor in-hospital outcomes [[OR 2.64 (95% CI 1.75-3.99), p < 0.00001, I² = 81%] and its subgroup which comprised of severe COVID-19 [OR 2.61 (95% CI 1.98-3.43), p < 0.00001, I² = 0%] and mortality from COVID-19 [RR 2.63 (95% CI 1.50-4.60), p = 0.0007, I² = 91%]. Meta-regression showed that the association was influenced by age (p = 0.05), but not by gender (p = 0.46) and dementia (p = 0.23).

CONCLUSIONS: Extra care and close monitoring should be provided to Parkinson’s Disease patients to minimize the risk of infections, preventing the development of severe and mortality outcomes.

PMID:33931304 | DOI:10.1016/j.parkreldis.2021.04.019

Int J Clin Pract. 2021 Apr 30:e14292. doi: 10.1111/ijcp.14292. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of the study was to evaluate the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and interleukin (IL)-6 in Chronic HBV-Infected patients.

METHODS: The present study was a single center, prospective, and randomized controlled trial. Twenty healthy volunteers and 30 HBeAg-negative patients with planned liver biopsy and treatment-naive diagnosed with Chronic hepatitis B (CHB) were included in the study. TNF-α, IL-1β, and IL-6 levels were measured in the serum of CHB patient and control groups using an ELISA. Results were compared statistically using a Mann Whitney U-test.

RESULTS: The mean age of the CHB group (20 men, 10 women) and the control group (10 men, 10 women) was 33.3 ± 9.7 (17-55) and 26.1 ± 12.3 (16-57), respectively. When the two groups were compared with the Mann Whitney U-test, TNF-α and IL-6 levels were found to be significantly higher in the CHB group compared to the control group (p = 0.003, p < 0.0001, respectively.). Although IL-1β levels were not statistically significant, they were higher in the CHB group compared to the controls (p = 0.07).

CONCLUSIONS: The results of our study showed that serum levels of TNF-α and IL-6 are increased in CHB patients.

PMID:33930244 | DOI:10.1111/ijcp.14292

J Nurs Manag. 2021 Apr 30. doi: 10.1111/jonm.13354. Online ahead of print.

ABSTRACT

AIM: To determine the relationship of nursing work environment and innovation support with nurses’ innovative behaviors and innovation outputs.

BACKGROUND: According to the Social Exchange Theory, nursing work environment must be regulated to support innovation for nurses’ innovative behaviors which results in useful innovation outputs.

METHODS: The sample of the research determined using the convenience sampling method consisted of 618 nurses working in four hospitals in Istanbul. In statistical analysis of the data, descriptive analyses, correlation and linear regression analysis were used.

RESULTS: It was found a significant correlation between nursing work environment and innovation support with innovative behavior and innovation outputs. It was found that innovative behavior was the variable that had a significant impact on nurses’ innovation outputs and the model explained 40.1% of the variance of innovation outputs. The model created for innovative behavior was determined to have an explanatory variance of 19.4%.

CONCLUSIONS: This study reveals the necessity for developing nurses’ innovative behaviors to increase innovation outputs, and examines the relationship of nurses’ innovative behaviors with nursing work environment and innovation support.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should create a nursing work environment that supports and develops nurses’ innovative behaviors.

PMID:33930243 | DOI:10.1111/jonm.13354

Int J Clin Pract. 2021 Apr 30:e14300. doi: 10.1111/ijcp.14300. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of the current study was to investigate Erectile dysfunction (ED) in asthma patients without comorbidity and the relationship between the level of asthma control and ED.

METHODS: Forty male patients aged 24-50 years with controlled-to-uncontrolled asthma and 20 healthy volunteers were included in this study. The International Index of Erectile Function Questionnaire (IIEF) for ED was used.

RESULTS: Evaluation of the IIEF scores for ED showed that 23 (57.5%) of the asthma patients and 4 (20.0 %) of the controls had various degrees of ED, and the difference was statistically significant. In total, 25% of asthma patients had mild ED, 22.5 %moderate ED,and10% severe ED. Severe, moderate and mild ED was more frequent in the asthma group. Of the 23 patients who had various degrees of ED, 13 were in the uncontrolled asthma group. While all asthma patients with severe ED were in the uncontrolled asthma group,of the 9 asthma patients with moderate ED, 6 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and one was in the controlled asthma group. Additionally, of the 10 asthma patients with mild ED, 3 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and 5 were in the controlled asthma group.

CONCLUSION: The current study showed that ED is frequent and more severe in asthma patients than controls with same age. A highly negative correlation was found between ED degree and asthma control severity.

PMID:33930236 | DOI:10.1111/ijcp.14300

Oral Dis. 2021 Apr 30. doi: 10.1111/odi.13895. Online ahead of print.

ABSTRACT

OBJECTIVES: In this study, we aimed to determine the relationship between oral health status and thyroid dysfunction.

METHODS: A population based cross-sectional analysis using data from the Korean National Health and Nutrition Examination Survey (KNHNES) was performed. We investigated the association between oral health-related parameters and the prevalence of thyroid diseases. In addition, the relationship between oral health status and thyroid function test (TFT) results was analyzed. One-way analysis of variances or chi-square test were used for comparisons between oral health-related parameters and presence of thyroid diseases. Univariable and multivariable logistic regression analyses were conducted to evaluate the associations between participants characteristics including oral health-related parameters and the abnormal results of TFTs.

RESULTS: A total of 18,034 adults was surveyed. Histories of thyroid diseases were found to be more common in people who brushed their teeth frequently or used oral hygiene products. However, histories of periodontitis and community periodontal index (CPI) did not show significant associations with histories of thyroid diseases. Among 14,860 participants without history of thyroid disorders, people having higher CPI values demonstrated higher probabilities of abnormal TFTs (OR 1.381, 95% CI 1.241-1.537, P<.0001); however, statistical significance was not found after adjusting for the other variables.

CONCLUSIONS: Our study demonstrated that good oral health-related behavior was associated with more frequent thyroid disease history. High CPI showed a significant association with TFT abnormalities; however, the significance of this association became lower when other variables such as age and sex were adjusted. Further studies will be needed to determine how the control of oral health-related conditions actually have a causal relationship with thyroid disease/dysfunction through prospective cohort studies.

PMID:33930233 | DOI:10.1111/odi.13895

Int J Clin Pract. 2021 Apr 30:e14302. doi: 10.1111/ijcp.14302. Online ahead of print.

ABSTRACT

BACKGROUND: Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes mellitus associated with high morbidity and mortality. Major risk factors for DPN include metabolic changes, duration of diabetes, nerve ischaemia and derangements in regeneration and nerve repair programs. Chemokines have been previously implicated in the pathogenesis of various neuropathies and neuropathic pain processes. The aim of this pilot study was to evaluate the association between plasma levels of chemokines (CXCL9, CXCL10 and CXCL11) with the presence of DPN in a cohort of type 2 diabetes (T2D) patients.

MATERIALS AND METHODS: We studied 73 patients with T2D: 36 with DPN and 37 without DPN. DPN was established through the Semmes-Weinstein test (SW). Plasma levels of circulating chemokines CXCL9, CXCL10, and CXCL11 were determined using Duoset ELISA kits (Abingdon, UK).

RESULTS: We found that levels of CXCL10 were significantly higher in patients with DPN than among patients without DPN (57.6 ± 38.3 vs. 38.1 ± 33.4 pg/mL, respectively; p = 0.034). Serum levels of chemokine CXCL9 were also higher among patients with DPN but did not reach statistical significance (188.1 ± 72.7 and 150.4 ± 83.6 pg/mL, respectively, p = 0.06).

CONCLUSIONS: Increased circulating levels of CXCL10 were associated with DPN in T2D patients, suggesting a role of this chemokine in the DPN. Determination of CXCL10 levels could be used as a marker for early detection and implementation of therapeutic strategies in order to reverse and prevent the DPN.

PMID:33930221 | DOI:10.1111/ijcp.14302

J Neuroimaging. 2021 Apr 30. doi: 10.1111/jon.12864. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: The first pass effect has been reported as a mechanical thrombectomy (MT) success metric in patients with large vessel occlusive stroke. We aimed to compare the clinical and neuroimagign outcomes of patients who had favorable recanalization (mTICI 2c or mTICI 3) achieved in one pass versus those requiring multiple passes.

METHODS: In this “real-world” multicenter study, patients with mTICI 2c or 3 recanalization were identified from three prospectively collected stroke databases from January 2016 to December 2019. Clinical outcomes were a favorable functional outcome at 90 days (modified Rankin Scale score 0-2), and the rate of symptomatic intracranial hemorrhage (ICH) any ICH, and 90-day mortality.

RESULTS: Favorable recanalization was achieved in 390/664 (59%) of consecutive patients who underwent MT (age 71.2 ± 13.2 years, 188 [48.2%] women). This was achieved after a single thrombectomy pass (n = 290) or multiple thrombectomy passes (n = 100). The rate of favorable clinical outcome was higher (41% vs. 28 %, p = .02) in the first pass group with a continued trend on multivariate analysis that did not reaching statistical significance (OR 1.68 95% confidence interval [CI] 1.0-2.95, p = .07). Similarly, the odds of any ICH were significantly lower (OR 0.56 CI 0.32-0.97, p = .03). A similar trend of favorable clinical outcomes was noticed on subgroup analysis of patients with M1 occlusion (OR 1.81 CI 1.01-3.61, p = .08).

CONCLUSION: The first-pass reperfusion was associated with a trend toward favorable clinical outcome and lower rates of ICH. These data suggest that the first-pass effect should be the mechanical thrombectomy procedure goal.

PMID:33930218 | DOI:10.1111/jon.12864

J Eur Acad Dermatol Venereol. 2021 Apr 30. doi: 10.1111/jdv.17330. Online ahead of print.

ABSTRACT

Although adjuvant radiotherapy has been used for cutaneous squamous cell carcinoma, its outcome benefits, especially for patients with clear surgical margins, have not been statistically estimated, and the characteristics that can indicate patients who require adjuvant therapy need to be validated with more evidence. We conducted a systematic review and meta-analysis of literature on the survival outcomes and prognostic factors in patients with cSCC treated by surgery with or without adjuvant radiotherapy. Twenty related studies involving 2,605 patients met our inclusion criteria. The significant survival outcomes of adjuvant radiotherapy included lower recurrence (OR, 0.56; 95% CI, 0.36 to 0.85), longer disease-free survival (OR, 2.17; 95% CI, 1.23 to 3.83), and longer overall survival (OR, 2.94; 95% CI, 1.75 to 4.91). Significant prognostic factors for poor outcomes were perineural invasion (HR, 1.61; 95% CI, 1.24 to 2.09), involved surgical margins (HR, 2.34; 95% CI, 1.42 to 3.83), and immunosuppression (HR, 3.02; 95% CI, 2.14 to 4.25) while adjuvant radiotherapy significantly contributed to better overall survival (HR, 0.47; 95% CI, 0.34 to 0.65). In conclusion, this systematic review suggests that in cutaneous squamous cell carcinoma patients with risk factors, including metastasis to the parotid gland, perineural invasion, and immunosuppression, the use of adjuvant radiotherapy may be beneficial irrespective of surgical margin status.

PMID:33930213 | DOI:10.1111/jdv.17330