Nevin Manimala

Arch Orthop Trauma Surg. 2021 Jul 24. doi: 10.1007/s00402-021-03972-3. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative pain is a major concern following scoliosis surgery. CEA (continuous epidural analgesia) is established in postoperative pain therapy as well as intravenous patient-controlled analgesia (IV-PCA). The purpose of this study was to compare the clinical outcomes of both methods.

METHODS: We retrospectively studied 175 children between 8 and 18 years who were subject to posterior scoliosis correction and fusion. Two main cohorts were formed: CEA with local anesthetic and opioids, and IV-PCA with opioids. Both groups further comprised two sub-cohorts: those who were mentally and/or physically healthy (H; n = 93 vs. n = 30) and those who were impaired (I; n = 26 vs. n = 26). The outcome parameters were the demand for pain medication, parameters of mobilization, and the presence of adverse reactions.

RESULTS: Healthy children who received CEA started mobilization 1 day earlier than children with IV-PCA (p = 0.002). First postsurgical defecation was seen earlier in all children who received CEA in both groups (H; Day 4 vs. Day 5, p = 0.011, I; Day 3 vs. Day 5, p = 0.044). Healthy children who received CEA were discharged from hospital 4 days earlier than their IV-PCA counterparts (p < 0.001). No statistically significant difference in postoperative nausea nor in vomiting was identified between groups. Transient neurological irritations were seen in 9.7% of the patients in the CEA group.

CONCLUSIONS: CEA provides appropriate pain management after scoliosis surgery, regardless of the patient’s mental status. It allows earlier postoperative defecation for all patients , as well as shorter hospitalization and an earlier mobilization for healthy patients.

PMID:34302521 | DOI:10.1007/s00402-021-03972-3

Abdom Radiol (NY). 2021 Jul 24. doi: 10.1007/s00261-021-03214-5. Online ahead of print.

ABSTRACT

OBJECTIVES: This study seeks to assess the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with transarterial embolization/transarterial chemoembolization (TAE/TACE) in hepatocellular carcinoma (HCC) with portal hypertension and arterioportal shunt (APS).

METHODS: Consecutive hospitalized patients having HCC accompanied by portal hypertension and APS were retrospectively analyzed. A total of 103 patients were enrolled. Of them, 26 patients were in Group A and 77 patients were in Group B according to the treatment protocol (Group A: TIPS plus TAE/TACE; Group B: TAE/TACE alone). The clinical outcomes and survival rate were compared between the two groups.

RESULTS: The mean survival time in Group A and Group B were 14 mo and 9.9 mo, respectively, with statistical difference (p = 0.043). The immediate APS improvement rate was 95.2% in Group A and 91.9% in Group B, respectively, with no signficant difference (p = 1.000). However, the first follow-up consultation revealed that APS improvement rate in Group A was more obvious (66.7% vs 27.4%, p = 0.001). Objective response rate of HCC tended to be greater in Group A compared with Group B (65.4% vs 38.7%, p = 0.019). Liver function parameters significantly increased in Group A than those in Group B. After TIPS placement, the mean portal pressure gradient decreased from 32.61 ± 8.87 mmHg to 15.61 ± 8.15 mmHg, with significant difference (p = 0.000). The rate of absorption of ascites and control of variceal bleeding were statistically different between the two groups (p = 0.045 and 0.039, respectively).

CONCLUSION: Our research suggests that TIPS combined with TAE/TACE seems to be safe and efficacious in patients with HCC accompanied by portal hypertension and APS, albeit may be accompanied by liver function damage.

PMID:34302511 | DOI:10.1007/s00261-021-03214-5

Lung. 2021 Jul 24. doi: 10.1007/s00408-021-00460-8. Online ahead of print.

ABSTRACT

PURPOSE: Pulmonary hamartoma is the most common benign tumor of the lung. We analyzed a 20-year historical series of patients with pulmonary hamartoma undergoing surgical resection, aiming to evaluate the characteristics, the outcomes, and the association between hamartoma and lung cancer.

METHODS: It was a retrospective multicenter study including the data of all consecutive patients with pulmonary hamartoma undergoing surgical resection. The end-points were to evaluate: (i) the characteristics of hamartoma, (ii) outcomes, and (iii) whether hamartoma was a predictive factor for lung cancer development RESULTS: Our study population included 540 patients. Upfront surgical or endoscopic resection was performed in 385 (71%) cases while in the remaining 155 (29%) cases, the lesions were resected 20 ± 3.5 months later due to increase in size. In most cases, lung sparing resection was carried out including enucleation (n = 259; 48%) and wedge resection (n = 230; 43%) while 5 (1%) patients underwent endoscopic resection. Only two patients (0, 2%) had major complications. One patient (0.23%) had recurrence after endoscopic resection, while no cases of malignant degeneration were seen (mean follow-up:103.3 ± 93 months). Seventy-six patients (14%) had associated lung cancer, synchronous in 9 (12%) and metachronous in 67 (88%). Only age > 70-year-old (p = 0.0059) and smokers > 20 cigarettes/day (p < 0.0001) were the significant risk factors for lung cancer.

CONCLUSION: PH was a benign tumor, with no evidence of recurrence and/or of malignant degeneration after resection. The association between hamartoma and lung cancer was a spurious phenomenon due to common risk factors.

PMID:34302497 | DOI:10.1007/s00408-021-00460-8

Neuro Oncol. 2021 Jul 24:noab172. doi: 10.1093/neuonc/noab172. Online ahead of print.

ABSTRACT

BACKGROUND: Neuro-oncology has grown tremendously since 2010, marked by increasing society membership, specialized clinical expertise, and new journals. Yet, modest improvement in racial/ethnic diversity amongst clinical trial participants, researchers and clinicians led us to conduct a survey to identify opportunities to enhance diversity and inclusiveness amongst neuro-oncology professionals.

METHODS: In summer 2020, the Women and Diversity Committee of the Society for Neuro-Oncology (SNO) distributed an anonymous online survey to members and affiliates including European Association of Neuro-Oncology (EANO), Asian Society for Neuro-Oncology (ASNO), Society for Neuro-Oncology Latin America (SNOLA) and Society for Neuro-Oncology Sub-Saharan Africa (SNOSSA). The survey captured personal and professional characteristics, biases, effective mentorship qualities, career service metrics and suggested field/society changes. Results were analyzed by geography, profession, age, racial/ethnic and sexual identity. Standard descriptive statistics characterized the study population.

RESULTS: The 386 respondents were predominantly female (58%) with a median age range of 40-49 years (31%), White (65%), and SNO members (97%). Most worked in North America (77%) in a research profession (67%). A majority of White respondents reported never experiencing biases (64%), while the majority of non-White respondents reported unconscious biases/microaggressions, followed by a lack of/limited mentorship. Qualitative assessments showcased that personal/professional success metrics were linked to needed improvements in diversity and inclusion efforts within the neuro-oncology field.

CONCLUSIONS: The prevalence of racial/ethnic biases and poor mentorship rates amongst underrepresented groups in neuro-oncology is high and potentially linked to the limited diverse representation amongst members and affiliates. These findings warrant a swift implementation of equity and inclusion practices within the neuro-oncology field.

PMID:34302487 | DOI:10.1093/neuonc/noab172

J Natl Cancer Inst. 2021 Jul 24:djab148. doi: 10.1093/jnci/djab148. Online ahead of print.

ABSTRACT

BACKGROUND: Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning.

METHODS: Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant.

RESULTS: Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type.

CONCLUSIONS: This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.

PMID:34302474 | DOI:10.1093/jnci/djab148

J Natl Cancer Inst. 2021 Jul 24:djab145. doi: 10.1093/jnci/djab145. Online ahead of print.

ABSTRACT

Among racial subgroups, Black men have the highest prostate cancer-specific death rate, yet they also exhibit prolonged overall survival compared to White men when treated with standard therapies, including sipuleucel-T. Differential immune responses may play a role in these observations. We compared circulating immune markers from fifty-four men (18 Black and 36 White men) with metastatic castrate-resistant prostate cancer who received sipuleucel-T and were enrolled on an immune monitoring registry. Markers included longitudinal serum cytokine concentrations, humoral responses, and cellular immunity from baseline until 52 weeks after sipuleucel-T administration. Black men had statistically significantly higher median concentrations of TH2-type (IL-4, IL-10, and IL-13) and inflammatory cytokines (IL-2, IL-12, and IL-6) compared to PSA-matched White men both at baseline and 52 weeks after sipuleucel-T (2-sided P < .05). No differences by race were seen in either the antigen-specific T cell response or in the humoral responses to the immunizing antigen PA2024 and select secondary antigens.

PMID:34302463 | DOI:10.1093/jnci/djab145

J Clin Nurs. 2021 Jul 23. doi: 10.1111/jocn.15973. Online ahead of print.

ABSTRACT

AIMS AND OBJECTIVES: This study aimed to investigate the effectiveness of a delirium prevention care protocol on pain, functional status, sleep quality and delirium prevention in patients with hip fractures.

BACKGROUND: The development of delirium following hip fracture is common among older patients. According to the National Institute for Health and Care Excellence, 30% of delirium cases are preventable. The prevention of delirium, a multifactorial syndrome, can be achieved through a multicomponent care protocol that targets specific risk factors for delirium.

DESIGN: A randomised controlled study was conducted according to the CONSORT 2010 guidelines. The Clinical Trial Registry number is NCT04188795.

METHODS: A total of 84 patients were assigned to two groups by block randomisation. The intervention group (n = 41) received nursing care according to a protocol and the control group (n = 43) received standard nursing care. Study data were collected using the demographic information form, the Confusion Assessment Method-Intensive Care Unit (CAM-ICU), the Barthel Index, the Mini Nutritional Assessment-short form and the Richards-Campbell Sleep Questionnaire (RCSQ). The pain of the patients was assessed by using a Visual Analog Scale (VAS).

RESULTS: The mean age of the patients was 80.6 years (standard deviation 8.0; range 65.0- 97.5 years), and the percentage of the male patients were 36.3%. No statistically significant differences were found between the groups in terms of pain and functional status in the preoperative period, on the first postoperative day, or in the predischarge period (p > 0.05 for each). The sleep quality of patients in the intervention group was significantly better than in the control group for all three time measurements (p < 0.05 for each). While 15% of patients in the control group developed delirium, no patient in the intervention group developed delirium (x² =6.486, p = 0.026).

CONCLUSION: This study demonstrated that a delirium prevention care protocol may reduce the incidence of delirium and improve sleep quality.

RELEVANCE TO PRACTICE: The study highlighted that nurses can contribute to preventing patients’ delirium using nonpharmacologic and independent nursing interventions.

PMID:34302312 | DOI:10.1111/jocn.15973

Biol Trace Elem Res. 2021 Jul 23. doi: 10.1007/s12011-021-02801-3. Online ahead of print.

ABSTRACT

The purpose of this meta-analysis is to comprehensively investigate the effect of iodine excess on children’s intellectual development in areas with high iodine levels in their drinking water. We systematically searched the electronic databases and identified 17 publications (16 in Chinese and 1 in English) on the effect of iodine excess on children’s intelligence published between January 31, 1985, and January 31, 2020. This meta-analysis included 14,794 children from 28 studies. The results showed that compared with the control group, the intelligence level of children in the high iodine group reduced significantly by 1.64 points (WMD=-1.64; 95% CI (-3.225, -0.049), Z=2.02, P<0.05). Subgroup analyses were performed according to the water iodine concentration, water iodine concentration of the control group, the intelligence test method, and regions of China (i.e., north and south). We noted that when the water iodine concentration was <300μg/L, 301-600μg/L, 600.1-900μg/L, and >900μg/L, the intelligence level of the high iodine groups decreased by varying degrees, although not statistically significant (all P>0.05). The water iodine concentration of the control group was divided into two groups (<150 μg/L and <100 μg/L) and the heterogeneity analysis showed that the heterogeneity of the control group decreased significantly when the concentration of water iodine was <150 μg/L, I² = 67.3%, P<0.001, which indicated a potential source of heterogeneity. The analyses by test method showed that among the studies which used the China Joint Raven’s test, the intelligence level of children in the high iodine group was 0.86 points lower than in the control group (P>0.05). Conversely, we observed that among the studies which used the China Binet intelligence test and the binaphthalene intelligence test of Tanzhida in Japan to evaluate children’s intelligence level, the intelligence level of children in the high iodine groups was significantly lower (3.65 points and 8.0 points, respectively) compared with the control groups (P<0.05). The analysis of the regions of China demonstrated that whereas the reduction in children’s intelligence level from excess iodine in the north of China was not statistically significant (WMD=-0.16, 95% CI (-2.18, 1.85), P>0.05), the association was statistically significant in the southern part of China (WMD=-1.86, 95% CI (-3.57, -0.09), P<0.05). This study found that high iodine concentration was statistically significantly associated with a decline in intelligence level in children. Comparatively, the intelligence level of children who were exposed to high iodine concentrations reduced significantly by 1.64 points. These findings have public health implications.

PMID:34302270 | DOI:10.1007/s12011-021-02801-3

Med Biol Eng Comput. 2021 Jul 24. doi: 10.1007/s11517-021-02403-0. Online ahead of print.

ABSTRACT

Breast cancer is one among the most frequent reasons of women’s death worldwide. Nowadays, healthcare informatics is mainly focussing on the classification of breast cancer images, due to the lethal nature of this cancer. There are chances of inter- and intra-observer variability that may lead to misdiagnosis in the detection of cancer. This study proposed an automatic breast cancer classification system that uses support vector machine (SVM) classifier based on integrated features (texture, geometrical, and color). The University of California Santa Barbara (UCSB) dataset and BreakHis dataset, which are available in public domain, were used. A classification comparison module which involves SVM, k-nearest neighbor (k-NN), random forest (RF), and artificial neural network (ANN) was also proposed to determine the classifier that best suits for the application of breast cancer detection from histopathology images. The performance of these classifiers was analyzed against metrics like accuracy, specificity, sensitivity, balanced accuracy, and F-score. Results showed that among the classifiers, the SVM classifier performed better with a test accuracy of approximately 90% on both the datasets. Additionally, the significance of the proposed integrated SVM model was statistically analyzed against other classifier models.

PMID:34302269 | DOI:10.1007/s11517-021-02403-0

J Pharmacokinet Pharmacodyn. 2021 Jul 23. doi: 10.1007/s10928-021-09770-z. Online ahead of print.

ABSTRACT

Delay differential equations (DDEs) are commonly used in pharmacometric models to describe delays present in pharmacokinetic and pharmacodynamic data analysis. Several DDE solvers have been implemented in NONMEM 7.5 for the first time. Two of them are based on algorithms already applied elsewhere, while others are extensions of existing ordinary differential equations (ODEs) solvers. The purpose of this tutorial is to introduce basic concepts underlying DDE based models and to show how they can be developed using NONMEM. The examples include previously published DDE models such as logistic growth, tumor growth inhibition, indirect response with precursor pool, rheumatoid arthritis, and erythropoiesis-stimulating agents. We evaluated the accuracy of NONMEM DDE solvers, their ability to handle stiff problems, and their performance in parameter estimation using both first-order conditional estimation (FOCE) and the expectation-maximization (EM) method. NONMEM control streams and excerpts from datasets are provided for all discussed examples. All DDE solvers provide accurate and precise solutions with the number of significant digits controlled by the error tolerance parameters. For estimation of population parameters, the EM method is more stable than FOCE regardless of the DDE solver.

PMID:34302262 | DOI:10.1007/s10928-021-09770-z