Nevin Manimala

Singapore Med J. 2021 Apr 16. doi: 10.11622/smedj.2021031. Online ahead of print.

ABSTRACT

INTRODUCTION: Medullary breast carcinomas (MBCs) are distinguished by circumscribed, high-grade morphology with dense chronic inflammation; they are associated with the basal phenotype but have a relatively good prognosis.

METHODS: This study aimed to review the clinicopathological features of MBCs diagnosed at the Department of Pathology, Singapore General Hospital and correlate them with immunohistochemical expression of hormonal markers and c-erbB-2, the basal markers p53, cytokeratin (CK) 14, epidermal growth factor receptor (EGFR) and 34BE12, and the follow-up outcome.

RESULTS: Using Ridolfi’s criteria for histologic reviews, 62 patients previously diagnosed as having ‘typical MBC’ (n = 26), ‘atypical MBC’ (n = 32) and ‘invasive carcinoma with focal medullary-like features’ (n = 4) were re-classified as follows: ‘typical MBC’ (n = 6; 9.7%), ‘atypical MBC’ (n = 46; 74.2%), and ‘non-medullary infiltrating carcinoma’ (n = 10; 16.1%). Clinicopathological parameters, including ethnicity, age, tumour size and concurrent ductal carcinoma in situ (DCIS), showed no statistically significant correlation with review diagnoses and immunohistochemical findings. Presence of lymphovascular invasion and nodal stage were significantly correlated with recurrence and breast cancer-related deaths, respectively. ER negativity was significantly correlated with triple positivity for basal markers CK14, EGFR and 34BE12, which comprised patients who showed a significantly decreased disease-free survival rate within a 10-15-year follow-up period.

CONCLUSION: Lymphovascular invasion and high nodal stage as well as triple negativity among typical and atypical MBCs that have basal-like phenotype represent a portion of invasive carcinomas with medullary features that may have poor outcomes in this otherwise relatively good prognostic group.

PMID:33866710 | DOI:10.11622/smedj.2021031

Int J Adolesc Med Health. 2021 Apr 15. doi: 10.1515/ijamh-2021-0018. Online ahead of print.

ABSTRACT

OBJECTIVES: Emerging evidence reveals disparities in suicidal behaviour and ideation exist between transgender and cisgender youth. It has been hypothesized that certain gender minority specific risk factors, such as experiences of victimization, could partially explain the mental health disparities between transgender and cisgender youth. We set out to explore whether transgender identity is associated with severe suicidal ideation among Finnish adolescents and whether the possible association persist when a range of covariates is controlled for.

METHODS: The study included 1,425 pupils (mean age [SD]=15.59 [0.41]) who participated in the study during a school lesson. Logistic regression was used to study associations between transgender identity and severe suicidal ideation.

RESULTS: Four models, each adding more covariates, were created. The final model revealed a statistically significant association between transgender identity and severe suicidal ideation, even though the association grew weaker as more covariates were added and controlled for.

CONCLUSIONS: The results indicate that transgender identity is associated with severe suicidal ideation even after prominent covariates or risk factors of suicidal behaviour and ideation have been taken into account.

PMID:33866702 | DOI:10.1515/ijamh-2021-0018

J Esthet Restor Dent. 2021 Apr 18. doi: 10.1111/jerd.12733. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyze translucency variations among four different contemporary esthetic ceramic systems having different shades and thicknesses.

MATERIAL AND METHODS: Ceramic specimens having different shades and translucencies were tested: leucite reinforced glass-ceramic (ECAD), conventional feldspathic ceramic (Noritake), zirconia reinforced lithium silicate glass-ceramic (Suprinity) and hybrid ceramic (Enamic). Specimens of 0.6, 0.9, 1.2, 1.5 and 2.0-mm thickness (n = 3/group, 615 total) were prepared. Translucency (TP) and Relative Translucency (RTP) Parameters were calculated from spectroradiometric color readings. Effects of shade and thickness for a given system were statistically analyzed using MANOVA and Tukey post-hoc multiple comparisons tests. Translucency variations were assessed comparatively with literature-based perceptibility and acceptability thresholds.

RESULTS: TP/RTP values of all ceramic materials decreased with increasing thickness. The most translucent specimens were 0.6-mm thick ECAD HT-A3.5 (TP = 31.99) and ECAD HT-C2 (RTP = 23.75), while the least translucent was 2-mm thick Enamic T-3 M2 (TP = 7.27; RTP = 4.79). Thickness and material type significantly influenced translucency (p < 0.001). Noritake and ECAD LT showed similar translucency values, as well as Suprinity HT and ECAD LT.

CONCLUSIONS: For ceramic restorations thicker than 0.9-mm, any thickness increase of 0.3-0.5 mm produces a perceptible but clinically acceptable translucency variation. Increases in thickness larger than 0.6-mm will result in an unacceptable translucency shift. Dental practitioners need to recognize key factors that influence translucency of ceramic restorations in order to choose the optimal material, shade, translucency, and thickness suitable for different clinical scenarios. While shade plays a minor role in translucency variation, ceramic type and restoration thickness significantly affect overall translucency.

PMID:33866673 | DOI:10.1111/jerd.12733

Int J Dent Hyg. 2021 Apr 18. doi: 10.1111/idh.12505. Online ahead of print.

ABSTRACT

OBJECTIVES: This clinical investigation examined the effects of brushing with a test toothpaste containing natural ingredients i.e., Clove (Syzgium Aromaticum), Aloe Vera (Aloe Barbadensis), Amla (Emblica Officinalis), Neem (Azadirachta Indica), Tulsi (Ocimum Basillicum) and Honey (from Apis Mellifera) along with zinc salts and fluoride in comparison to a dentifrice formulated with fluoride alone on dental plaque and gingivitis over a 6-month period.

MATERIALS & METHOD: One-hundred-eighty (180) subjects with mean plaque index scores greater than 1.5 (Turskey Modified Quigley Hein Plaque Index) and gingival index scores greater than 1.0 (Loe and Sillness gingival index) in good general health and who met other study criteria were enrolled in the clinical study. Subjects were evaluated for plaque, gingival index scores and were randomly assigned to perform twice daily oral hygiene with either the test or the control toothpaste for the next six months. One-hundred-fifty (150) subjects [test toothpaste (n=72) and control toothpaste (n=78)] completed the 6 month clinical study with evaluable data. Post treatment assessments identical to baseline were conducted after 3 months and 6 months use of assigned product after subjects refrained from oral hygiene for 12 hours prior to each evaluation. Comparisons of the treatment groups with respect to baseline-adjusted gingival, plaque and bleeding index scores at the follow-up examinations were performed using Analyses of Covariance (ANCOVA). All statistical tests of hypotheses were two sided, and employed a level of significance of p<0.05.

RESULTS: No significant intergroup differences were noted between treatment groups for age and gender by two sample t-test and chi-square analyses respectively (p>0.05). Further the treatment groups demonstrated no differences at baseline for plaque, gingival and bleeding index scores by a two sample t test (p>0.05). At 3 month and 6 month examination, the test toothpaste exhibited progressive reductions in plaque, gingival and bleeding scores as compared to control toothpaste as showed by ANCOVA (p<0.001). In comparison to the control, the test demonstrated reductions of 23.5%, 25.6% and 73.3% for dental plaque, gingival index and bleeding index outcomes respectively at the final visit. Reductions in the frequencies of sites with higher clinical scores were noted over the study with more sites registering improvements in the test group than in the control.

CONCLUSIONS: Routine oral hygiene with the test toothpaste formulated with herbal ingredients and zinc demonstrated a clinical adjunctive improvement in oral hygiene and parameters of gingival health as compared to brushing with a fluoride toothpaste.

PMID:33866666 | DOI:10.1111/idh.12505

Int J Clin Pract. 2021 Apr 18:e14232. doi: 10.1111/ijcp.14232. Online ahead of print.

ABSTRACT

BACKGROUND: Acute appendicitis (AA) is the most common cause of surgery performed for acute abdomen. The standard treatment for AA patients has been appendectomy for more than a century. Use of broad-spectrum antibiotics, the medical treatment option has come to the fore in the treatment of uncomplicated AA.

AIM: Evaluate whether White Blood Cell (WBC), platelet count, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Red Cell Distribution Width (RDW) and C-reactive protein (CRP) values of patients diagnosed with uncomplicated AA clinically, with laboratory tests and radiologically with abdominal computed tomography (CT) could be a marker for choosing medical or surgical treatment.

MATERIALS AND METHODS: 519 patients aged between 20 and 65 years who were diagnosed with uncomplicated AA by abdominal CT in our centre between January 2016 and January 2019 were retrospectively analysed. The presence of at least one of the criteria of 7 mm or more appendix diameter and oedema or fluid accumulation around the appendix was accepted as uncomplicated AA. After the diagnosis of AA, 223 patients were treated medically, while 296 patients underwent laparoscopic appendectomy. The first group included patients who were treated medically and the second group included patients who underwent laparoscopic appendectomy.

RESULTS: Group 2 patients had higher mean platelet count (p <.005) and RDW (p = .003) values compared to Group 1 patients, while mean PDW (p <.001) values were lower compared to those of Group 1 patients. The differences between the mean WBC, CRP and MPV values of the groups were not statistically significant (p>0.05).

CONCLUSIONS: Recently, studies supporting antibiotic therapy have been conducted in patients diagnosed with AA. As a result, we think that PDW, RDW, and platelet values in patients diagnosed with uncomplicated AA may be a guide in choosing patients to be treated with surgery or antibiotics.

PMID:33866650 | DOI:10.1111/ijcp.14232

Photochem Photobiol. 2021 Apr 18. doi: 10.1111/php.13432. Online ahead of print.

ABSTRACT

There are limited and controversial studies that address the role of vitamin D (vitD), a vitamin with immunomodulatory effects, in myasthenia gravis (MG), a neuromuscular autoimmune disease. We aimed to assess 25-hydroxy vitamin D (25(OH)D) levels and to evaluate possible associations with the clinical severity and other biomarkers of the disease. Serum levels of 25(OH)D, anti-acetylcholine receptor antibodies, and complement factor C5a were measured in MG patients (n=66) and healthy volunteers (HV) (n=25). Participants were evaluated through questionnaires to determine vitD intake and sunlight exposure. Severity scores were registered for MG patients. We found an 89.4% of MG individuals with non-sufficient levels of vitD, in comparison with 68.0% in the group of HV (OR=3.96; p=0.024). In addition, there was an inverse correlation between 25(OH)D levels and one of the scores (p=0.037 r=-0.26, CI₉₅ =-0.49 to -0.0087). However, when we compared 25(OH)D median serum levels between MG patients and HV, no statistically significant differences have been found. This is the first report of vitD status in a cohort of Argentinean MG patients, where we found that patients are more likely to have non-sufficient levels of vitD compared to healthy people and that patients with more severe disease have lower levels of vitD.

PMID:33866582 | DOI:10.1111/php.13432

Stat Med. 2021 Apr 18. doi: 10.1002/sim.8991. Online ahead of print.

ABSTRACT

Polytomous regression models generalize logistic models for the case of a categorical outcome variable with more than two distinct categories. These models are currently used in clinical research, and it is essential to measure their abilities to distinguish between the categories of the outcome. In 2012, van Calster et al proposed the polytomous discrimination index (PDI) as an extension of the binary discrimination c-statistic to unordered polytomous regression. The PDI is a summary of the simultaneous discrimination between all outcome categories. Previous implementations of the PDI are not capable of running on “big data.” This article shows that the PDI formula can be manipulated to depend only on the distributions of the predicted probabilities evaluated for each outcome category and within each observed level of the outcome, which substantially improves the computation time. We present a SAS macro and R function that can rapidly evaluate the PDI and its components. The routines are evaluated on several simulated datasets after varying the number of categories of the outcome and size of the data and two real-world large administrative health datasets. We compare PDI with two other discrimination indices: M-index and hypervolume under the manifold (HUM) on simulated examples. We describe situations where the PDI and HUM, indices based on multiple comparisons, are superior to the M-index, an index based on pairwise comparisons, to detect predictions that are no different than random selection or erroneous due to incorrect ranking.

PMID:33866577 | DOI:10.1002/sim.8991

J Surg Oncol. 2021 Apr 18. doi: 10.1002/jso.26456. Online ahead of print.

ABSTRACT

BACKGROUND: Financial disclosure (FD) highlights potential conflicts of interest but is often overlooked at academic conferences.

METHODS: Retrospective review of 2015-2019 Society of Surgical Oncology Cancer Symposium oral presentation slide and/or verbal FD frequency, duration, and content.

RESULTS: Of 963 presentations, 331 (34%) omitted disclosure slide/verbalization. 575 (60%) included a slide, 551 (57%) gave verbal disclosure and 133 (14%) stated relevance. 164 presentations (17%) cited 1 + FD. 2019 had greater median FDs/talk than 2015-2018 (3.50 vs. 2.00; p = .010). Compared to 2015-2018, 2019 yielded shorter median slide display of all disclosures (2.00 s vs. 2.47 s; p = .006), median 1 + FD display (3.37 s vs. 4.81 s; p = .04) and median 1 + FD verbalization (2.81 s vs. 3.66 s; p = .54). 2019 all disclosure verbalization increased (1.97 s vs. 1.14 s; p < .001). Multivariable modeling showed longer display with 2015-2018 (+1.3 s, 95% confidence interval [CI] -0.06 to 2.5 s, p = .04), <4 authors (+3.2 s, 95% CI: 2.1-4.3 s; p < .001) and longer verbalization with 2019 (+0.8 s, 95% CI: 0.2-1.4 s; p = .01), relevance (+1.0 s, 95% CI: 0.4-1.6 s; p = .002), ≤ 4 authors (+0.8 s, 95% CI: 0.3-1.3 s, p < .001) and noncommercial FD (+3.8 s, 95% CI: 2.0-5.0 s; p < .001). The five most cited commercial entities were in 39% of talks.

CONCLUSION: Presenters’ FDs were brief or omitted. Despite FD increase, disclosure time decreased. Improved FD attention will highlight potential COIs.

PMID:33866567 | DOI:10.1002/jso.26456

J Pers. 2021 Apr 18. doi: 10.1111/jopy.12639. Online ahead of print.

ABSTRACT

INTRO: Need for Cognition (NFC) refers to a personality trait describing the relatively stable intrinsic motivation of individuals to invest cognitive effort in cognitive endeavors. Higher NFC is associated with a more elaborated, central information processing style and increased recruitment of resources in cognitively demanding situations. To further clarify the association between cognitive resources and NFC, we examined in two studies how NFC relates to executive functions as basic cognitive abilities.

METHODS: In Study 1, 189 healthy young adults completed a NFC scale and a battery of six commonly used inhibitory control tasks (Stroop, antisaccade, stop-signal, flanker, shape-matching, word-naming). In Study 2, 102 healthy young adults completed the NFC scale and two tasks for each of the three executive functions inhibitory control (go-nogo, stop-signal), shifting (number-letter, color-shape) and working memory updating (two-back, letter-memory).

RESULTS: Using a Bayesian approach to correlation analysis, we found no conclusive evidence that NFC was related to any executive function measure. Instead, we obtained even moderate evidence for the null hypothesis.

CONCLUSION: Both studies add to more recent findings that shape the understanding of NFC as a trait that is less characterized by increased cognitive control abilities but rather by increased willingness to invest effort and exert self-control via motivational processes.

PMID:33866562 | DOI:10.1111/jopy.12639

J Surg Oncol. 2021 Apr 18. doi: 10.1002/jso.26499. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing an orthopedic surgery for bone or soft tissue sarcoma are at increased venous thromboembolism (VTE) risk. Unfortunately, there is a lack of thromboprophylaxis guidelines in this population. The purpose of this systematic review was to determine the soft tissue and bone sarcoma VTE rate and to explore the thromboprophylaxis regimens used.

METHODS: The databases MEDLINE, EMBASE, and CENTRAL were queried using keywords related to VTE and long bone malignancy requiring surgical intervention to 2020. Included studied reported VTE rate in patients with surgically managed extremity sarcoma. Descriptive statistics and weighted mean totals were calculated.

RESULTS: A total of 2082 studies were screened and 23 studies were included. The overall VTE rate was 2.9%, with a rate of 3.7% and 1.4% in patients with bone and soft tissue sarcomas, respectively. Low-molecular-weight heparin was the most commonly used chemoprophylaxis.

CONCLUSIONS: There is a high VTE rate following sarcoma surgery. The VTE rate is higher in bone sarcoma surgery, which may be attributed to differences in surgery and postoperative recovery. There was no consensus on the duration or type of thromboprophylaxis used. Future research is needed to determine the most effective thromboprophylaxis regimen in patients with sarcoma and whether individualized thromboprophylaxis is required.

PMID:33866561 | DOI:10.1002/jso.26499