Nevin Manimala

Clin Res Hepatol Gastroenterol. 2021 Mar 1;45(6):101631. doi: 10.1016/j.clinre.2021.101631. Online ahead of print.

ABSTRACT

OBJECTIVE: Radioiodine (Iodine-131, ¹³¹I) ablation is a standard treatment for differentiated thyroid cancer (DTC) after thyroidectomy. Hepatotoxicity is a rare side effect of ¹³¹I, and little information is available on the hepatotoxicity of ¹³¹I ablation for post-surgical DTC patients with hepatitis B virus (HBV) infection.

METHODS: We performed a retrospective study of 94 post-surgical DTC patients between November 2012 and August 2015 in our hospital. All the patients had been screened for HBV infection and divided into HBV group and non-HBV group. Clinical data were compared between the two groups.

RESULTS: 14 patients with HBV infection and 80 patients without HBV infection were analyzed. The baseline characteristics of the two groups had no statistical differences. Incidence of hepatotoxicity was higher in HBV group than in non-HBV group and HBV infection was confirmed as a risk factor of hepatotoxicity by univariate and multivariate regression analysis.

CONCLUSION: Post-surgical DTC patients with HBV infection were prone to hepatotoxicity by ¹³¹I ablation treatment. Physicians should pay more attention to the liver function of patients at risk.

PMID:33662775 | DOI:10.1016/j.clinre.2021.101631

Clin Res Hepatol Gastroenterol. 2021 Mar 1;45(6):101638. doi: 10.1016/j.clinre.2021.101638. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVE: Metabolic associated fatty liver disease (MAFLD), characterized by intra-hepatic fat accumulation, will soon be the leading cause of end-stage liver disease. Lysosomal Acid Lipase (LAL) is a key enzyme in lipid metabolism. We investigated its activity in patients with biopsy-proven MAFLD.

METHODS: Prospective cross-sectional study in patients with biopsy-proven MAFLD. Blood LAL-activity (pmol/punch/h) was measured with dried blood spot extracts using Lalistat 2. Demographic, clinical, and laboratory data were collected.

RESULTS: 101 adult patients were recruited. Among them, 11.9% had a diagnosis of MAFLD without steatohepatitis and 88.1% had MAFLD with steatohepatitis. The median of LAL-activity in patients with MAFLD was 76.8 pmol/punch/h. MAFLD patients with steatohepatitis showed an increase in gamma-glutamyl transferase (p = 0.042), insulin (p = 0.001), homeostatic model assessment for insulin resistance (HOMA-IR, p = 0.001) and advanced liver fibrosis (p < 0.001), compared to cases of MAFLD without steatohepatitis. There was no statistical difference in LAL-activity between the cases (p = 0.296). When considering LAL-activity above and below 77 pmol/punch/h as a cut-off value, patients with reduced LAL-activity had a significant increase in necroinflammatory activity according to the METAVIR score (p = 0.040), and NAFLD activity score (NAS, p = 0.031) compared to cases with higher LAL-activity.

CONCLUSION: Our findings suggest that reduced LAL-activity is associated with increased necroinflammatory activity and severity of the NAS. A better knowledge of the role of LAL may provide new insights into the pathogenesis and progression of MAFLD.

PMID:33662773 | DOI:10.1016/j.clinre.2021.101638

Health Expect. 2021 Mar 4. doi: 10.1111/hex.13221. Online ahead of print.

ABSTRACT

BACKGROUND: Consistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients’ needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions.

METHODS: Cross-sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression.

RESULTS: 94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%-87.4% across behaviours) and helpful (range 82.8%-85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long-term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions.

CONCLUSIONS: Patients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients.

PATIENT OR PUBLIC CONTRIBUTION: The questionnaire was piloted among a convenience sample prior to distribution.

PMID:33662180 | DOI:10.1111/hex.13221

J Diabetes Investig. 2021 Mar 4. doi: 10.1111/jdi.13539. Online ahead of print.

ABSTRACT

AIMS/INTRODUCTION: We estimated the hazards of cardiovascular diseases (CVDs) and early all-cause mortality in Korean adults according to the presence of recently-diagnosed type 2 diabetes (T2D) (T2D for <5 years) and insulin use.

MATERIALS AND METHODS: We used the Korean National Health Insurance Service-National Sample Cohort database (2002-2015) for this longitudinal population-based study. Among adults aged ≥40 years without baseline CVD, individuals without diabetes or with recently-diagnosed T2D were selected (N=363,919). The hazard ratios (HRs) for myocardial infarction (MI), stroke, and all-cause mortality during follow-up were analyzed according to three groups categorized by the presence of T2D and insulin use.

RESULTS: Within a mean 7.8 years, there were 5,275 MIs, 7,220 strokes, and 15,834 deaths. The hazards for outcomes were higher in the insulin-treated T2D group than in the non-diabetes group [HR (95% CI): 2.344 (1.870-2.938) for MI, 2.420 (1.993-2.937) for stroke, and 3.037 (2.706-3.407) for death], higher in the non-insulin-treated T2D group than in the non-diabetes group [HR (95% CI): 1.284 (1.159-1.423) for MI, 1.435 (1.320-1.561) for stroke, and 1.135 (1.067-1.206) for death], and higher in the insulin-treated T2D group than in the non-insulin-treated T2D group [HR (95% CI): 1.914 (1.502-2.441) for MI, 1.676 (1.363-2.060) for stroke, and 2.535 (2.232-2.880) for death].

CONCLUSIONS: Recently-diagnosed T2D patients showed increased risks of incident CVDs and premature mortality, and insulin-treated group demonstrated an additional increase in the risks of these outcomes in adults with recently-diagnosed T2D, suggesting the need for intensified cardio-protective interventions for adults with insulin-treated T2D.

PMID:33662172 | DOI:10.1111/jdi.13539

Eur J Haematol. 2021 Mar 4. doi: 10.1111/ejh.13614. Online ahead of print.

ABSTRACT

OBJECTIVES: To validate the predictive value on time to first treatment (TTFT) of AIPS-E and IPS-E evaluated in an independent cohort of newly diagnosed and non-referred Binet stage A CLL patients enrolled in the O-CLL1-GISL protocol (clinicaltrial.gov identifier: NCT00917540).

METHODS: A cohort of 292 newly diagnosed Binet A CLL cases has been enrolled in the study. Patients from several Italian Institutions were prospectively enrolled within 12 months of diagnosis into the O-CLL1-GISL protocol RESULTS: The majority of patients were male (62%); median age was 60.4 years, 102 cases (34.9%) showed unmutated IGHV genes, 8 cases (2.8) the presence of del(11q)/del(17p), 142 cases (48.6%) the presence of palpable lymph nodes and 146 cases (50%) and ALC >15×10⁹ /l. After a median follow-up of 7.2 years, 130 patients underwent treatment. According to the AIPS-E, 96 patients were classified as low-risk, 128 as intermediate-risk, and 68 as high-risk. These groups showed significant differences in terms of TTFT. The C-statistic was 0.71 (P<0.0001) for predicting TTFT. According to IPS-E, 77 patients were classified as low-risk, 135 as intermediate-risk, and 80 as high-risk. These groups showed significant differences in terms of TTFT. The C-statistic was 0.705 (P<0.0001) for predicting TTFT.

CONCLUSIONS: Our data confirm an accurate prognostic utility of both AIPS-E and IPS-E at the individual patient level. These data may be useful for a precise stratification of early-stage patients.

PMID:33662164 | DOI:10.1111/ejh.13614

JAMA Netw Open. 2021 Mar 1;4(3):e210775. doi: 10.1001/jamanetworkopen.2021.0775.

ABSTRACT

IMPORTANCE: Ibuprofen is widely used in children worldwide, especially in those with cancer, fever, or trauma. However, large and high-quality studies of the association between ibuprofen and acute kidney injury (AKI) in children have been lacking.

OBJECTIVE: To examine the association between the use of ibuprofen and the risk of hospital-acquired AKI in hospitalized children in China.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed the cohort of the Epidemiology of AKI in Chinese Hospitalized Patients (EACH) study, a large, multicenter retrospective study of 3 044 023 patients who were admitted to 1 of 25 academic medical centers in China between January 1, 2013, and December 31, 2015. Patient-level data were obtained from the electronic health record system of the participating centers. Hospitalized children aged 1 month to 18 years who had prescriptions and a certain number of serum creatinine (SCr) tests were included. Children with end-stage renal disease, community-acquired AKI, low baseline SCr level (<10 μmol/L), high standardized baseline SCr level (>4 times the sex- and age-specific reference value), or missing diagnosis code were excluded. Data analysis was conducted from January 1, 2020, to August 30, 2020.

EXPOSURES: Exposure to ibuprofen was coded as a time-dependent dichotomous variable.

MAIN OUTCOMES AND MEASURES: Baseline SCr level was calculated for each patient as the mean of all available SCr values between the 30 days prior to admission and the first SCr testing within the first 3 days of hospitalization. Acute kidney injury was defined as an increase in SCr level of 26.5 μmol/L or higher within 48 hours or by 50% or more over the baseline value, according to the Kidney Disease: Improving Global Outcomes guidelines.

RESULTS: Among the 50 420 children (mean [SD] age, 5.0 [5.2] years; 30 640 boys [60.8%]) included in this study, 5526 (11.0%) used ibuprofen and 3476 (6.9%) developed hospital-acquired AKI during hospitalization. Ibuprofen use was associated with a statistically significantly increased risk of hospital-acquired AKI (hazard ratio [HR], 1.23; 95% CI, 1.14-1.34) after adjusting for confounders. Ibuprofen use was associated with a greater hazard in children who had chronic kidney disease vs those without (HR, 2.31 [95% CI, 1.73-3.10] vs 1.19 [95% CI, 1.09-1.29]), required intensive care vs those without this need (HR, 1.47 [95% CI, 1.24-1.75] vs 1.18 [95% CI, 1.07-1.29]), or were older vs younger (>10 years and >1 year to 10 years vs 1 month to 1 year) (HR, 1.64 [95% CI, 1.32-2.05]; 1.36 [95% CI, 1.23-1.52] vs 0.99 [95% CI, 0.86-1.13]). Dose-response analysis suggested that the association of ibuprofen with the risk of hospital-acquired AKI was dose-dependent.

CONCLUSIONS AND RELEVANCE: This study found that ibuprofen was widely used and associated with an increased risk of hospital-acquired AKI in hospitalized children in China. The judicious use of ibuprofen and close monitoring of kidney function in children are needed.

PMID:33662136 | DOI:10.1001/jamanetworkopen.2021.0775

Phys Chem Chem Phys. 2021 Mar 4. doi: 10.1039/d1cp00031d. Online ahead of print.

ABSTRACT

Lanthanide elements have well-documented similarities in their chemical behavior, which make the valuable trivalent lanthanide cations (Ln3+) particularly difficult to separate from each other in water. In this work, we apply ab initio molecular dynamics simulations to compare the free energies (ΔGads) associated with the adsorption of lanthanide cations to silica surfaces at a pH condition where SiO- groups are present. The predicted ΔGads for lutetium (Lu3+) and europium (Eu3+) are similar within statistical uncertainties; this is in qualitative agreement with our batch adsorption measurements on silica. This finding is remarkable because the two cations exhibit hydration free energies (ΔGhyd) that differ by >2 eV, different hydration numbers, and different hydrolysis behavior far from silica surfaces. We observe that the similarity in Lu3+ and Eu3+ ΔGads is the result of a delicate cancellation between the difference in Eu3+ and Lu3+ hydration (ΔGhyd), and their difference in binding energies to silica. We propose that disrupting this cancellation at the two end points, either for adsorbed or completely desorbed lanthanides (e.g., via nanoconfinment or mixed solvents), will lead to effective Ln3+ separation.

PMID:33662085 | DOI:10.1039/d1cp00031d

Int J Prosthodont. 2021 Mar 3. doi: 10.11607/ijp.6345. Online ahead of print.

ABSTRACT

PURPOSE: To measure the retrieval force required to remove 1.5-mm-thick CAD/CAM zirconia copings cemented on zirconia (Zr) and titanium (Ti) stock implant abutments after a single application of erbium-doped yttrium scandium gallium garnet (Er:YSGG) laser.

MATERIALS AND METHODS: A total of 60 monolithic Zr copings were cemented on Zr and Ti implant abutments with either a resin-modified glass-ionomer (RelyX Luting Plus Cement, 3M ESPE; Rx) or a zinc oxide eugenol cement (Temp-Bond, Kerr; Tb). These abutment-coping specimens were randomly divided into 12 groups based on laser application (vs control [C]), abutment type (Zr vs Ti), cement (Rx vs Tb), and storage condition (dry [D] vs saline water [W]). Er:YSGG laser was applied at 6 W, 30% water-60% air, and 20 Hz (300 mJ/pulse energy) postcementation following a defined pattern. The force required to remove all the cemented copings from their abutments was measured on a universal testing machine (Instron model 4204). Descriptive statistics, multi-factor analysis of variance, and post hoc Tukey honest significant difference tests (α = .05) were performed.

RESULTS: The mean peak force values at removal of the Zr abutment groups were 470.3 ± 151.33 N (ZrRxC), 161.7 ± 19.29 N (ZrRxD), 316.03 ± 95.24 N (ZrRxW), 103.27 ± 24.53 N (ZrTbC), 39.33 ± 6.21 N (ZrTbD), and 20.33 ± 6.45 N (ZrTbW); and for the Ti abutment groups were 349.80 ± 106.82 N (TiRxC), 84.63 ± 14.02 N (TiRxD), 177 ± 62.57 N (TiRxW), 54.77 ± 9.10 N (TiTbC), 22.67 ± 4.32 N (TiTbD), and 11.57 ± 2.30 N (TiTbW).

CONCLUSION: Within the limitations of this study, it can be concluded that Er:YSGG laser allows for easier removal of cemented Zr copings with lower removal forces, with Ti abutment groups requiring lower forces than Zr abutment specimens. No significant difference was seen between laser and control groups for Tb compared to Rx. Er:YSGG laser shows great clinical promise for predictable retrievability of cemented, monolithic Zr implant crowns, especially with stronger resin-based cement such as Rx. With further clinical evidence, this could be very useful for clinicians managing cement-retained implant crown complications.

PMID:33662063 | DOI:10.11607/ijp.6345

Int J Prosthodont. 2021 Mar 3. doi: 10.11607/ijp.6983. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effect of monolithic zirconia-based occlusal surfaces on signs and symptoms of temporomandibular disorders (TMD) after short-term clinical service.

MATERIALS AND METHODS: Patients were supplied with multi-unit fixed dental prostheses (FDP) featuring monolithic zirconia-based occlusal surfaces. Prior to prosthetic treatment and 1 year after insertion anamnestic facial pain, pain with palpation of muscles/joints and joint sounds were examined.

RESULTS: Of the 50 patients, 43 were re-examined after 1 year. Perceived facial pain was not present, pain with palpation occurred in 2 patients, and TMJ sounds decreased; differences were not statistically significant (P ≥ .058).

CONCLUSION: Single tooth-supported multiunit FDPs featuring monolithic zirconia-based occlusal surfaces did not affect TMD-associated signs and symptoms.

PMID:33662060 | DOI:10.11607/ijp.6983

Int J Prosthodont. 2021 Mar 3. doi: 10.11607/ijp.7367. Online ahead of print.

ABSTRACT

PURPOSE: To compare patient adaptation to and satisfaction with new complete dentures fabricated with a duplication construction protocol (DCP) using two different occlusal schemes, bilateral balanced (BBO) and lingualized (LO).

MATERIALS AND METHODS: Twenty complete denture wearers who received replacement DCP dentures participated in this study. Ten participants received complete dentures with a BBO scheme, and the other 10 received DCP dentures with an LO scheme. All of them evaluated their prostheses subjectively through the Oral Health Impact Profile-20 (OHIP-20) and the Complete Denture Satisfaction (CDS) questionnaires before treatment and at 3- and 6-month posttreatment intervals. The new prostheses were also normatively evaluated by recording the location and number of sore spots present at the scheduled early adjustment visits. Data were analyzed with nonparametric tests to identify differences in patient responses between groups and within each group at each evaluation interval point (α = .05).

RESULTS: The within-group comparisons revealed statistically significant improvement for both denture groups (P < .05), while the between-group comparisons did not record statistically significant differences at the overall evaluation period (P > .05). Significant within-group differences were recorded in the pain, functional limitation, and psychologic disability domains of the OHIP-20 questionnaire and the comfort, esthetics, and stability domains of the CDS questionnaire.

CONCLUSION: The patients’ adaptation to and satisfaction with newly constructed DCP dentures improved significantly for both BBO and LO denture groups throughout the evaluation period. The mean number of early adjustment visits was equal for both the BBO and LO denture groups.

PMID:33662056 | DOI:10.11607/ijp.7367