Nevin Manimala

J Cardiothorac Vasc Anesth. 2021 Jul 9:S1053-0770(21)00573-5. doi: 10.1053/j.jvca.2021.07.001. Online ahead of print.

ABSTRACT

OBJECTIVES: Neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker that has been evaluated across a variety of surgical disciplines and is widely predictive of poor postoperative outcome, but its value in cardiac surgery is unclear. The authors did this systematic review and meta-analysis to determine the impact of elevated perioperative NLR on survival after cardiac surgery.

DESIGN: Systematic review and meta-analysis of study-level data.

SETTING: Multiple hospitals involved in an international pool of studies.

PARTICIPANTS: Adults undergoing cardiac surgery.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: The authors searched multiple databases from inception until November 2020. They generated summary hazard ratios (HR) and odds ratios (OR) for the association of elevated preoperative NLR with long-term and short-term mortality following cardiac surgery. They separately reported on elevated postoperative NLR. Between-study heterogeneity was explored using metaregression. The authors included 12 studies involving 13,262 patients undergoing cardiac surgery. Elevated preoperative NLR was associated with worse long-term (>30 days) (hazard ratio [HR] 1.56; 95% CI [confidence interval], 1.18-2.06; 8 studies) and short-term (<30 days) mortality (OR 3.18; 95% CI, 1.90-5.30; 7 studies). One study reported the association of elevated postoperative NLR with long-term mortality (HR 8.58; 95% CI, 2.55-28.85). There was considerable between-study heterogeneity for the analysis of long-term mortality (I² statistic 94.39%), which mostly was explained by study-level variables, such as the number of variables adjusted for by included studies and how many of these significantly increased the risk of long-term mortality, high risk of bias, and number of study centers, as well as participant level factors, such as average participant age and hypertension prevalence.

CONCLUSIONS: Perioperative NLR is an independent predictor of short-term and long-term postoperative mortality following cardiac surgery. Further research is required to determine which patient-level factors modify the prognostic value of NLR and to evaluate its role in routine clinical practice.

PMID:34404595 | DOI:10.1053/j.jvca.2021.07.001

J Foot Ankle Surg. 2021 Jul 20:S1067-2516(21)00263-5. doi: 10.1053/j.jfas.2021.07.009. Online ahead of print.

ABSTRACT

Twenty percent of ankle fractures present with concomitant syndesmosis injury which results in poor clinical outcomes. Surgical stabilization of the syndesmosis can be achieved with either trans-syndesmotic screws or a suture button device. The aim of this study is to investigate the clinical efficacy of suture button fixation and trans-syndesmotic screw fixation in the treatment of ankle fracture combined with distal tibiofibular syndesmosis injury. A retrospective analysis was conducted by enrolling 76 patients with ankle fractures combined with distal tibiofibular syndesmosis injury who were admitted in our trauma center from January 2018 to January 2019, including 34 cases of suture button group and 42 cases of the syndesmotic screw group with a mean follow-up period of 16 ± 7 (range 12-21) months. The demographic data included gender, age, injury mechanism, AO classification and the operation duration were recorded, the radiographic and clinical outcomes were determined by tibiofibular clear space, tibiofibular overlap distance, complications, and the Olerud-Molander Ankle Score at the last follow-up. All the indexes were compared between the 2 groups to discover the related statistical differences. With the numbers available, no significant difference could be detected in the surgical duration, tibiofibular clear space, tibiofibular overlap distance, total complication rate, and middle-term Olerud-Molander Ankle scores between the 2 groups. However, the suture button fixation group showed higher early stage Olerud-Molander Ankle scores (p = .027) and shorter full weightbearing time (p = .018) than that of syndesmotic screw fixation group. Considering the outcomes, we conclude that the suture button fixation not only shows equivalent efficacy to the traditional syndesmotic screw, but also has advantages of allowing early weightbearing, low requirements for routine removal.

PMID:34404589 | DOI:10.1053/j.jfas.2021.07.009

Eur J Surg Oncol. 2021 Aug 11:S0748-7983(21)00686-7. doi: 10.1016/j.ejso.2021.08.016. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of cytotoxic chemotherapy on the expression of programmed cell death 1 (PD-1) and its ligand (PD-L1) in cancer cells and peritumoral cells are unclear. The aim of this study was to investigate the impact of neoadjuvant chemotherapy on PD-1 and PD-L1 expression in adenocarcinomas of the gastroesophageal junction.

METHODS: PD-1 and PD-L1 expression in cancer cells and tumor-infiltrating lymphocytes in paired diagnostic biopsies and surgical specimens from patients with pretreated and curatively resected adenocarcinomas of the gastroesophageal junction were evaluated by immunohistochemistry.

RESULTS: Paired tumor samples were available from 40 patients. PD-1 expression in cancer cells (p < 0.001; Exact Symmetry Test) and tumor-infiltrating lymphocytes (p < 0.001; Exact Symmetry Test) increased significantly after neoadjuvant therapy. Furthermore, we observed a significant decrease in PD-L1 expression in cancer cells (p = 0.003) after neoadjuvant therapy was observed.

CONCLUSION: In this study we could show that tumor-cell expression of PD-1 and PD-L1 was significantly altered in patients with adenocarcinomas of the gastroesophageal junction after receiving neoadjuvant chemotherapy. Based on these observations, patients might profit from the combined use of cytotoxic chemotherapy and the blockade of the PD-1 axis.

PMID:34404561 | DOI:10.1016/j.ejso.2021.08.016

J Reconstr Microsurg. 2021 Aug 17. doi: 10.1055/s-0041-1733922. Online ahead of print.

ABSTRACT

BACKGROUND: Microsurgical free flaps have largely supplanted pedicled flaps as the gold standard for head and neck cancer reconstruction. However, incidence of postoperative complications after accounting for patient comorbidities based on choice of reconstruction has not been well-defined in the literature in recent years.

METHODS: Patients undergoing head and neck reconstruction were identified in the 2011-2016 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database and stratified into groups by free flap, myocutaneous pedicled flap, and other reconstruction. Demographics were analyzed and covariates balanced using overlap propensity score-based weighting. Logistic regression was used for binary outcomes and Gamma generalized linear model was used for length of stay.

RESULTS: A total of 4,712 patients met inclusion criteria out of which 1,297 patients (28%) underwent free flap, 208 patients (4%) pedicled flap, and 3,207 patients (68%) had other, or no reconstruction performed. After adjusting for patient and disease-specific factors, pedicled flap reconstruction was associated with a higher risk of deep vein thrombosis (odds ratio [OR] = 2.64, confidence interval [CI] 1.02-6.85, p = 0.045), sepsis (OR = 2.95, CI 1.52-5.71, p = 0.001), and infection (OR = 2.03, CI 1.39-2.96, p <0.001) compared with free flap reconstruction. Free flaps had the longest mean operative time compared with the other two groups (unadjusted 578 vs. 440 vs. 326, p <0.001). Pedicled flaps had a lower incidence of bleeding requiring transfusion (adjusted OR = 0.65, CI 0.50-0.85, p = 0.002), and lower incidence of prolonged mechanical ventilation (adjusted OR = 0.33, CI 0.12-0.92, p = 0.034) compared with free flaps. There was no difference in rates of reoperation, hospital readmission, or hospital length-of-stay between pedicled and free flaps.

CONCLUSION: Myocutaneous pedicled flaps are associated with higher overall short-term postoperative complications compared with free flaps in head and neck reconstruction, which demonstrate a more favorable morbidity profile without significantly impacting hospital readmission, reoperation, or length-of-stay.

PMID:34404103 | DOI:10.1055/s-0041-1733922

J Reconstr Microsurg. 2021 Aug 17. doi: 10.1055/s-0041-1732431. Online ahead of print.

ABSTRACT

BACKGROUND: Ethnicity has been shown to play a role in disparate coagulative responses between East Asian and Caucasian patients undergoing nonmicrovascular surgery. In this study, we sought to further investigate this hematologic phenomenon between the two ethnic groups within the field of microsurgical breast reconstruction.

METHODS: A systematic review examining the reported incidence of microvascular thrombosis and all-site bleeding among breast free flaps in East Asians and Westerners was performed. Statistical analysis was performed using the chi-square test.

RESULTS: Ten East Asian studies with 581 flaps and 99 Western studies with 30,767 flaps were included. A statistically significant higher rate of thrombotic complications was found in Westerners compared with East Asians (4.2 vs. 2.2%, p = 0.02). Conversely, bleeding events were more common in East Asians compared with Westerners (2.6 vs. 1.2%, p = 0.002).

CONCLUSION: There appears to be an ethnicity-based propensity for thrombosis in Westerners and, conversely, for bleeding in East Asians, as evident by the current systematic review of microvascular breast reconstruction data. It is therefore advisable to consider ethnicity in the comprehensive evaluation of patients undergoing microsurgical procedures.

PMID:34404099 | DOI:10.1055/s-0041-1732431

J Athl Train. 2021 Aug 17. doi: 10.4085/1062-6050-0208.21. Online ahead of print.

ABSTRACT

CONTEXT: Repetitive joint use is a risk factor for osteoarthritis, which is a leading cause of disability. Sports requiring a bat or racket to perform repetitive high-velocity impacts may increase the risk of thumb-base osteoarthritis. However, this hypothesis remains untested.

OBJECTIVE: To determine if a history of participation in racket or bat sports is associated with the prevalence of thumb-base osteoarthritis.

DESIGN: Descriptive epidemiology study.

SETTING: Osteoarthritis Initiative. Four clinical sites in the United States.

PARTICIPANTS: We included men and women from the recruited from the community. Eligible participants had dominant hand radiographic readings, hand symptom assessments, and historical physical activity survey data.

MAIN OUTCOME MEASURES: A history of exposure to racket or bat sports (baseball/softball, racquetball/squash, badminton, table tennis, tennis [doubles/singles]) was based on self-reported recall data covering 3 age ranges (12-18 years, 19-34 years, 35-49 years). Prevalent radiographic thumb-base osteoarthritis was defined as someone with Kellgren-Lawrence grade≥2 in the first carpometacarpal joint or scaphotrapezoidal joint at the OAI baseline visit. Symptomatic thumb-base osteoarthritis was defined as the presence of radiographic osteoarthritis and hand/finger symptoms.

RESULTS: In total, we included 2309 participants. Among 1049 men, 355 (34%) and 56 (5%) had radiographic or symptomatic thumb-base osteoarthritis, respectively; and among 1260 women, 535 (42%) and 170 (13%), respectively. After adjusting for age, race, and education level, we found no statistically significant associations between a history of any racket or bat sport participation and thumb-base osteoarthritis (radiographic or symptomatic; odds ratios range from 0.82 to 1.34).

CONCLUSIONS: Within a community-based cohort, a self-reported history of participation in racket or bat sports was not associated with an increased odds of having radiographic or symptomatic thumb-base osteoarthritis in the dominant hand.

PMID:34404092 | DOI:10.4085/1062-6050-0208.21

J Athl Train. 2021 Aug 17. doi: 10.4085/1062-6050-0006.21. Online ahead of print.

ABSTRACT

CONTEXT: Athletic trainers’ (ATs) job satisfaction has been extensively researched, yet little is known about how satisfaction relates to organizational culture.

OBJECTIVE: To examine ATs’ level of job satisfaction and organizational fit perceptions within their employment setting.

DESIGN: Cross-sectional study.

SETTING: Web-based questionnaire.

PATIENTS OR OTHER PARTICIPANTS: 5,704 ATs (full-time employment, nonacademic appointment) were contacted via email; 841 participants began our survey (access rate = 14.7%), and 285 completed the survey (5.0% response rate; 33.9% completion rate; men = 107 (37.5%), women = 178 (62.5%); age = 34.8±9.9 years; employment setting = 34.7% NCAA D1 (n=99), 18.9% NCAA DII (n=54), 29.5% NCAA DIII (n=84), and 16.9% other.

MAIN OUTCOME MEASURE(S): Participants responded to an online survey consisting of demographic questions, a 36-item Likert scale Job Satisfaction Survey (JSS), and the Cable and Judge revision of O’Reilly, Chatman, and Caldwell’s 40-item ranking organizational cultures profile (OCP) survey. Multiple linear regression models for total or subscale job satisfaction were used to analyze the data. All models adjusted for the same demographic measures and the independent variables of interest were created from the organizational culture survey responses.

RESULTS: Coworkers (min=9, max=24, rho=0.79), communications (min=9, max=24, rho=0.78), and work itself (min=4, max=24, rho=0.71) were the most correlated with the total job satisfaction score (min=96, max=175). 54% of respondents selected adaptability, stability, and taking individual responsibility as one of their two most characteristic attributes in the organizational culture profile. 83% of respondents indicated being aggressive, high pay for good performance, and being distinctive/different from others as their two least characteristic traits.

CONCLUSIONS: ATs’ job satisfaction was impacted most by organizational factors, such as coworkers and communication, as well as individual attributes like adaptability, stability, and taking personal responsibility.

PMID:34404089 | DOI:10.4085/1062-6050-0006.21

PLoS One. 2021 Aug 17;16(8):e0256239. doi: 10.1371/journal.pone.0256239. eCollection 2021.

ABSTRACT

BACKGROUND: In the Indian state of Bihar, visceral leishmaniasis (VL) is a major public health issue that has been aggravated by the rising incidence of new Human immunodeficiency virus (HIV) infections. In endemic areas, the risk of VL infections in patients living with HIV (PLHIV) is higher. It is important to investigate the disease-related knowledge, attitude, and practices (KAP) of PLHIV in Bihar in order to monitor HIV/VL co-infection. Adequate knowledge, a positive attitude, and good practices for VL control are essential to stamp out the disease. This study investigated the KAP towards VL in HIV patients attending antiretroviral therapy (ART) clinic at ICMR-RMRIMS, Patna.

METHODS: A questionnaire based cross-sectional study was performed among 120 HIV patients aged ≥18 years, to evaluate their KAP regarding visceral leishmaniasis. For the KAP indicators, each correct answer received a score of 1, while unsure and incorrect responses received a score of 0. Descriptive statistics and logistic regression were used for the analysis. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.

RESULTS: The study population had a male (68.30%) preponderance with a mean age of 37.03 years ± 9.80 years of standard deviation. The majority (93.30%) of the study participants had previously heard about VL. Only 32.10% of those who had heard about VL knew that the disease was transmitted by the sandfly. Most (80.40%) of the study respondents were ignorant of the sandfly breeding grounds. The vast majority (75.90%) had no idea how to recognize sandflies and were unaware of their biting time, leishmaniasis transmission season, and preventive practices. Although PLHIV are vulnerable to VL, only 27.70% of them agreed that VL is a fatal disease if untreated, and 42.90% believed they wear not at risk of developing the disease. Regarding the control methods of sandflies, 28.60% of participants did not use any methods to avoid sandfly bites. The multivariable analysis revealed that occupation and family history were the two independent predictor variables of the knowledge index. Age and gender were significantly associated with attitude towards VL. Participants working as laborers had significantly lesser odds (AOR: 0.248, 95% CI: 0.073-0.844) to follow good preventive practices. There were significantly higher odds of having good practice among participants aged 18-40 years (AOR: 6.866, 95% CI: 1.694-27.834) and those residing in urban areas (AOR: 4.159, 95% CI: 1.317-13.139) than their peers. Overall, 27.7% of respondents were knowledgeable, 41.1% had a positive mindset, and 33.9% had strong VL preventive habits, according to the study.

CONCLUSION: The study determined a remarkable gap in the knowledge attitude and practices towards VL among PLHIV. This underscores the need of augmented health education initiatives for PLHIV in endemic areas for good VL awareness and preventive practices.

PMID:34404087 | DOI:10.1371/journal.pone.0256239

Gan To Kagaku Ryoho. 2021 Aug;48(8):987-991.

ABSTRACT

Cancer cachexia is defined as a multifactorial syndrome that causes anorexia and an ongoing loss of skeletal muscle mass (with or without loss of fat mass). When patients got cachexia, the effectiveness and tolerance for anti-cancer therapy is reduced, leading to their poor prognosis. Although known as such disease, there had been no effective cure for cancer cachexia. Ghrelin is a peptide hormone that promotes appetite and improve cachexia. However, there is a limitation as a drug because its half-life is short and must be intravenous injected. Anamorelin is a first novel drug, an orally active, non- peptidic ghrelin mimetic and growth hormone secretagogue approved in Japan in January 2021. Like ghrelin, anamorelin also increases the appetite and lean body mass of patients with cancer cachexia. On the other hand, in clinical trials, there was no statistical significance for increasing the 6-minute walk test distance and recovering non-dominant hand grip strength. As for the functional recovery, a new program has been developed for non-pharmacotherapy with nutritional and exercise interventions. These 2 kinds of interventions will become effective anti-cachexia therapy. Research is also underway to produce anti-cachexia drugs other than anamorelin. Somes are already in their clinical trials. Anti-cachexia therapy will be a new option for treating advanced cancer.

PMID:34404062

Int J Sports Physiol Perform. 2021 Aug 17:1-7. doi: 10.1123/ijspp.2020-0834. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to assess neuromuscular performance capabilities over an in-season mesocycle in early-career professional soccer players and examine the relationship with training workload.

METHODS: Neuromuscular performance capabilities (isometric knee extensor: peak force, rate of force development, and peak twitch force) of 12 professional soccer players were assessed weekly over a 6-week period. Training and match workload were also recorded over the same period for each player (high-intensity running distance). Changes in neuromuscular performance and workload variables were analyzed.

RESULTS: There was evidence of fluctuations in neuromuscular performance capability over the mesocycle that reached statistical (P < .05) and practical (13.3% [peak-to-peak]) significance alongside interweek heterogeneity in training and match workload (∼17.5% [coefficient of variation], P < .05). Congruence among fluctuating patterns of intramesocycle training load and concomitant neuromuscular performance responses was noted over time for acute training load and acute:chronic workload ratio with peak force and rate of force development.

CONCLUSION: Neuromuscular performance capabilities fluctuate over an in-season mesocycle and are influenced by high-intensity running workload, emphasizing the need for acute monitoring in elite soccer players.

PMID:34404025 | DOI:10.1123/ijspp.2020-0834