Nevin Manimala

Cancer Rep (Hoboken). 2021 Jul 8:e1490. doi: 10.1002/cnr2.1490. Online ahead of print.

ABSTRACT

BACKGROUND: There is strong evidence supporting the efficacy of exercise oncology programs to improve physical and psychosocial outcomes during active treatment. However, there is a paucity of evidence on the effect of exercise on healthcare utilization and cost analyzes of exercise oncology programs.

AIMS: Our objective was to assess the effects of a pragmatic exercise oncology program (ENACT) during active chemotherapy treatment on healthcare utilization and associated costs.

METHODS: We conducted post-hoc analyzes on 160 ENACT participants and 75 comparison participants matched on cancer site, stage, age range, and gender. We obtained complete healthcare utilization histories for each patient (specific to emergency department [ED] visits and hospital admissions) coinciding with their participation in ENACT. A sub-analysis was conducted for advanced stage breast, gastrointestinal, and pancreatic cancer patients.

RESULTS: Healthcare costs for patients who participated in the ENACT exercise oncology intervention were numerically lower than healthcare costs for the comparison group, even after accounting for the cost of the intervention. However, the differences were not statistically significant.

CONCLUSION: Our findings suggest that an exercise oncology program during active chemotherapy treatment are at least cost neutral for all cancer patients, including advanced stage cancers. Additional research is warranted to evaluate the potential for exercise oncology programs to reduce healthcare utilization, particularly in advanced cancer patients.

PMID:34236137 | DOI:10.1002/cnr2.1490

Hemodial Int. 2021 Jul 8. doi: 10.1111/hdi.12971. Online ahead of print.

ABSTRACT

INTRODUCTION: Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with excess morbidity and mortality. Higher serum phosphate is associated with adverse cardiovascular outcomes in maintenance HD patients; however, its association with IDH has not previously been assessed.

METHODS: This is an analysis of a prospective cohort of 969 HD patients (80,968 HD sessions) receiving HD at a large dialysis organization (LDO) and a post-hoc analysis of 1838 HD patients (10,594 HD sessions) in the Hemodialysis study (HEMO), a multicenter randomized controlled trial that examined standard or high-dose HD and low-flux or high-flux membranes. Unadjusted and adjusted mixed effects regression models were fit to determine the association of pre-HD serum phosphate with IDH, defined as a nadir intra-HD systolic blood pressure (SBP) <90 mmHg.

FINDINGS: In the LDO cohort, baseline mean pre-HD serum phosphate was 5.2 ± 1.7 mg/dl. IDH occurred in 15.6% of HD sessions. In the adjusted model, higher pre-HD serum phosphate (per 1 mg/dl) was associated with a 12% increased risk of IDH (aOR 1.12, 95% CI 1.10-1.13, p <0.001). In exploratory models where pre-HD laboratory values were available, the effect estimate was attenuated but remained statistically significant (aOR 1.05; 95% CI 1.02-1.08; p <0.01). Participants in the highest (compared with the lowest) quartile of pre-HD serum phosphate had a 56% greater risk of IDH in the adjusted model (aOR Q4:Q1 1.56; 95% CI 1.44-1.68, p <0.001). The association of higher phosphate with IDH was consistent in the HEMO data.

DISCUSSION: Higher pre-HD serum phosphate is independently associated with an increased risk of IDH. As HD may cause an acute decline in serum phosphate, future studies to investigate the mechanisms of this association are warranted.

PMID:34236130 | DOI:10.1111/hdi.12971

J Magn Reson Imaging. 2021 Jul 8. doi: 10.1002/jmri.27824. Online ahead of print.

ABSTRACT

BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) is widely accepted as a reliable diagnostic scheme for hepatocellular carcinoma (HCC) in at-risk patients. However, its application is hampered by substantial complexity and suboptimal diagnostic sensitivity.

PURPOSE: To propose data-driven modifications to the LI-RADS version 2018 (v2018) major feature system (rLI-RADS) on gadoxetate disodium (EOB)-enhanced magnetic resonance imaging (MRI) to improve sensitivity and simplicity while maintaining high positive predictive value (PPV) for detecting HCC.

STUDY TYPE: Retrospective.

POPULATION: Two hundred and twenty-four consecutive at-risk patients (training dataset: 169, independent testing dataset: 55) with 742 LR-3 to LR-5 liver observations (HCC: N = 498 [67%]) were analyzed from a prospective observational registry collected between July 2015 and September 2018.

FIELD STRENGTH/SEQUENCE: 3.0 T/T2-weighted fast spin-echo, diffusion-weighted spin-echo based echo-planar and three-dimensional (3D) T1-weighted gradient echo sequences.

ASSESSMENT: All images were evaluated by three independent abdominal radiologists who were blinded to all clinical, pathological, and follow-up information. Composite reference standards of either histopathology or imaging follow-up were used.

STATISTICAL TESTS: In the training dataset, LI-RADS v2018 major features were used to develop rLI-RADS based on their associated PPV for HCC. In an independent testing set, diagnostic performances of LI-RADS v2018 and rLI-RADS were computed using a generalized estimating equation model and compared with McNemar’s test. A P value <0.05 was considered statistically significant.

RESULTS: The median (interquartile range) size of liver observations was 13 mm (7-27 mm). The diagnostic table for rLI-RADS encompassed 9 cells, as opposed to 16 cells for LI-RADS v2018. In the testing set, compared to LI-RADS v2018, rLI-RADS category 5 demonstrated a significantly superior sensitivity (76% vs. 61%) while maintaining comparably high PPV (92.5% vs. 94.1%, P = 0.126).

DATA CONCLUSION: Compared with LI-RADS v2018, rLI-RADS demonstrated improved simplicity and significantly superior diagnostic sensitivity for HCC in at-risk patients.

LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

PMID:34236120 | DOI:10.1002/jmri.27824

Int J Clin Pract. 2021 Jul 8:e14497. doi: 10.1111/ijcp.14497. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study aimed to investigate the contribution of cone-beam computed tomography (CBCT) to the diagnosis of obstructive sleep apnoea syndrome (OSAS).

METHODS: The present study investigate the relationships among body mass index (BMI), upper airway, septum deviation, nasal cavity width, airway, and the hard and soft palate width using CBCT images of 64 patients obtained in Uşak University Faculty of Dentistry. The study included 31 (8 female and 23 male; mean age: 52.52 ± 10.01 years) and 33 patients (12 female and 21 male; mean age: 47.39 ± 10.27 years) with and without OSAS, respectively. Between-group comparisons of non-normally and normally distributed variables were performed using the Mann-Whitney U test and Student’s t-test, respectively. Spearman’s correlation analysis was used to determine the relationship between quantitative data. Statistical significance was evaluated at P < .01 and P < .05.

RESULTS: There were significant differences between groups in the BMI, nasal septum position, hard and soft palate width, maxillary skeletal width, and palatal alveolar angle (P < .01). In addition it was also found that BMI was higher, the nasopharyngeal airway was longer, and the soft palate was longer and wider in males. (P = .001; P < .01).

CONCLUSION: This study concluded that patients with OSAS had marked narrowing of the upper airway, nasal cavity and maxillary width, shortening and enlargement of the soft palate, and marked increase in BMI. However, to gather sufficiently reliable data for routine use in orthodontic analyses, there is a need for greater number of samples to improve the database.

PMID:34236117 | DOI:10.1111/ijcp.14497

Environ Toxicol Chem. 2021 Jul 8. doi: 10.1002/etc.5154. Online ahead of print.

ABSTRACT

Bumblebees can be exposed to neonicotinoid pesticides through nectar and pollen collected from treated crops, which can cause lethal and sublethal effects in these non-target pollinators. However, the body distribution of the compound after exposure to neonicotinoids in bumblebees is not well studied. Bumblebee colonies (Bombus terrestris, n = 20) were exposed to field-realistic concentrations of clothianidin through artificial nectar (3.6 µg/L – 13 µg/L) for nine days. Comparison of the nominal- to the measured exposure in nectar indicated good compliance, confirming the applicability of the method. When quantified, clothianidin showed a concentration-dependent occurrence in the head and body of workers (head: <0.2 – 2.17 µg/kg, body: <0.2 – 3.17 µg/kg), and in the body of queens (<0.2 – 2.49 µg/kg), although concentrations were below that measured in the nectar (Bioaccumulation factor = 0.2). Exposure to clothianidin did not affect mortality nor brood production, nor have a statistically significant effect on nectar consumption and size of food storage. However, visual inspection suggests higher nectar consumption of nectar with low clothianidin content compared to nectar with no or high clothianidin content. Our results show that dietary clothianidin is taken up in bumblebees, but does not bioaccumulate to elevated levels compared to exposure. Still, clothianidin may elicit responses that affect feeding behaviour of the pollinator B. terrestris, although our endpoints were not significantly affected. This article is protected by copyright. All rights reserved.

PMID:34236107 | DOI:10.1002/etc.5154

Environ Toxicol Chem. 2021 Jul 8. doi: 10.1002/etc.5152. Online ahead of print.

ABSTRACT

Deriving water quality criteria (WQC) for aquatic risk assessment, requires sufficient toxicity data, which can determine the accuracy of WQC. Given that toxicity data varies between test species and endpoints, there is a great need to compare such data to generate the most suitable data set for WQC derivation. In this study, a series of 11 ammonia exposure bioassays were conducted on Chironomidae species in either China or Australia, with test species and test endpoints varied (2 Chironomus sp., enzymatic up to lethal endpoints, and NOEC up to LC50 as endpoint metrics). It was found that there were no statistically significant differences between toxicity results generated from China compared to Australia using Chironomus sp., indicating that published data on native species generated in different countries could be appropriate for inclusion in the development of local Chinese WQC. In addition, Chironomidae larvae laboratory-based toxicity value (LC50 of 384.6 mg/L) was lower than that of the in situ field-based toxicity value (LC50 ≥ 451.2 mg/L) where sensitive life stages are used and, specifically for C. riparius, endpoints linked to biochemical and gene expression effects could be as sensitive, or more sensitive than chronic endpoints, both of which were more sensitive than acute endpoints. These findings help in the development of WQC by demonstrating the suitability of inclusion of toxicity data from a range of sources, as well as adding to the overall pool of knowledge regarding sensitivity to ammonia which can be used in aquatic risk assessment. This article is protected by copyright. All rights reserved.

PMID:34236106 | DOI:10.1002/etc.5152

Mov Disord. 2021 Jul 8. doi: 10.1002/mds.28703. Online ahead of print.

ABSTRACT

BACKGROUND: There are limited data regarding the effectiveness of levodopa-carbidopa intestinal gel (LCIG) for dyskinesia.

OBJECTIVE: Compare the effectiveness of LCIG versus oral optimized medical treatment (OMT) for dyskinesia in patients with advanced Parkinson’s disease (PD) using the Unified Dyskinesia Rating Scale (UDysRS).

METHODS: This phase 3b, open-label, multicenter, 12-week, interventional study (NCT02799381) randomized 63 LCIG naïve patients with advanced PD (UDysRS ≥30) to LCIG (N = 30) or OMT (N = 33) treatment. Dyskinesia impact was assessed at baseline through week 12 using the UDysRS. PD-related motor and non-motor symptoms, and quality of life (QoL) were also assessed.

RESULTS: Dyskinesias measured by UDysRS were significantly reduced in the LCIG group (n = 24; -17.37 ± 2.79) compared with the OMT group (n = 26; -2.33 ± 2.56) after 12 weeks (-15.05 ± 3.20; 95% CI, -21.47 to -8.63; P < 0.0001). At week 12, LCIG versus OMT also demonstrated significant improvements in “On” time without troublesome dyskinesia (P = 0.0001), QoL (P < 0.0001), global impression of change (P < 0.0001), activities of daily living (P = 0.0006), and Unified Parkinson’s Disease Rating Scale (UPDRS) Part III (P = 0.0762). Treatment-emergent adverse events were reported in 27 (44.3%) patients (LCIG, 18 [64.3%]; OMT, 9 [27.3%]). Serious adverse events occurred in 2 (7.1%) LCIG-treated patients.

CONCLUSIONS: LCIG significantly reduced dyskinesia compared with OMT. LCIG showed efficacy for treatment of troublesome dyskinesia in patients with advanced PD while demonstrating benefits in both motor and non-motor symptoms and QoL. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

PMID:34236101 | DOI:10.1002/mds.28703

Laryngoscope. 2021 Jul 8. doi: 10.1002/lary.29746. Online ahead of print.

ABSTRACT

OBJECTIVES/HYPOTHESIS: Dermal filler (DF) is a widely used nonsurgical option for facial rejuvenation with a rapidly expanding market. Physician payments by DF industry leaders have yet to be characterized. We sought to investigate trends in physician-industry payments by DF companies over 6 years. Differences in payments based on physician specialty and time were characterized.

STUDY DESIGN: Database review.

METHODS: The Open Payments Database was queried from 2013 to 2018. Payments made by the three largest DF companies by market share to otolaryngologists, plastic surgeons, and dermatologists were analyzed. Total dollars paid, number of payments made, type of payments made, and total number of specialists paid were recorded. One-way ANOVA was used for statistical analysis.

RESULTS: Otolaryngologists, plastic surgeons, and dermatologists received average annual payments of $0.36 million, $6.3 million, and $6.6 million respectively (P < .001). An average of 330 otolaryngologists, 2,128 plastic surgeons, and 5,980 dermatologists were paid annually (P < .001). Accredited speaking arrangements, consulting fees, and royalty/licensing fees comprised the majority of dollars paid to physicians.

CONCLUSIONS: Average physician payment by DF companies exceeds $12 million annually, with otolaryngologists receiving significantly less compared to plastic surgeons and dermatologists.

LEVEL OF EVIDENCE: Not applicable Laryngoscope, 2021.

PMID:34236083 | DOI:10.1002/lary.29746

Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi. 2021 Aug;37(8):736-740.

ABSTRACT

Objective To detect and analyze the distribution characteristics of platelet antibodies in inpatients and explore the causes of platelet antibodies, so as to provide data support for improving the quality of blood transfusion. Methods A total of 38 840 patients were selected. The platelet-related antibodies were detected by Capture-P solid-phase detection system, and the positive rate of antibodies was analyzed statistically. Results Of the 38840 inpatients, 3989 were positive for platelet antibodies, with a positive rate of 10.27%. The positive rates of male and female patients were 8.7% and 11.5%, respectively. The positive rate of platelet antibodies in patients under 18 years old was 6.98% which was significantly lower than that in patients ≥66 years old and 18~65 years old. The positive rates of patients with pregnancy history and blood transfusion history increased significantly, which were 14.4% and 14.7%, respectively. The positive rate of patients with blood system diseases and liver cirrhosis with gastrointestinal bleeding diseases was over 20%. The positive rates of patients in the Hematology Department, Intensive Care Department and Obstetrics Department ranked the top three, with the positive rates of 15.17%, 14.97%, and 13.67%, respectively. The positive rates of platelet antibodies in patients with blood types B and AB were lower than those in patients with blood types A and O. Conclusion In clinical platelet transfusion, the influence of the patients’ age, gender, hospitalized diseases, hospitalized department and other factors on platelet antibodies should be considered to reduce the occurrence of platelet transfusion refractoriness.

PMID:34236034

Ultrason Imaging. 2021 Jul 8:1617346211029542. doi: 10.1177/01617346211029542. Online ahead of print.

ABSTRACT

To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5-45.2 mm) detected in 180 women (age: 21-87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a “penetrating vessel” was assessed separately. Differences in vascularization patterns (chi² test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant (p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity (p = .02 and p = .01 for each reader, respectively), rim pattern (p < .001 for both readers) or combined pattern (p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern (p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI (p < .001 for both readers) and in the malignant FBLs (p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64-0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60-0.74]) and PDI (AUC = 0.67, 95%CI = [0.60-0.74]) though not significantly (p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good (k-score 0.85-0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.

PMID:34236008 | DOI:10.1177/01617346211029542