Nevin Manimala

J Patient Rep Outcomes. 2021 Jun 5;5(1):43. doi: 10.1186/s41687-021-00312-2.

ABSTRACT

BACKGROUND: Disparities in US physician burnout rates across age, gender, and specialty groups as measured by the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI) are well documented. We evaluated whether disparities in US physician burnout are explained by differences in the MBI’s functioning across physician age, gender, and specialty groups.

METHODS: We assessed the measurement equivalence of the MBI across age, gender, and specialty groups in multi-group item response theory- (IRT-) based differential item functioning (DIF) analyses using secondary, cross-sectional survey data from US physicians (n = 6577). We detected DIF using two IRT-based methods and assessed its impact by estimating the overall average difference in groups’ subscale scores attributable to DIF. We assessed DIF’s practical significance by comparing differences in individuals’ subscale scores and burnout prevalence estimates from models unadjusted and adjusted for DIF.

RESULTS: We detected statistically significant age-, gender-, and specialty- DIF in all but one MBI item. However, in all cases, average differences in expected subscale-level scores due to DIF were < 0.10 SD on each subscale. Differences in physicians’ individual-level subscale scores and burnout symptom prevalence estimates across DIF- adjusted and unadjusted IRT models were also small (in all cases, mean absolute differences in individual subscale scores were < 0.04 z-score units; prevalence estimates differed by < 0.70%).

CONCLUSIONS: Age-, gender-, and specialty-related disparities in US physician burnout are not explained by differences in the MBI’s functioning across these demographic groups. Our findings support the use of the MBI as a valid tool to assess age-, gender-, and specialty-related disparities in US physician burnout.

PMID:34089412 | DOI:10.1186/s41687-021-00312-2

AMB Express. 2021 Jun 5;11(1):82. doi: 10.1186/s13568-021-01243-3.

ABSTRACT

The current study was aimed at investigating the prevalence of the mutations upstream of the oprD coding region and its promoters among imipenem-resistant and sensitive Pseudomonas aeruginosa isolated from educational hospitals in Yazd City, Iran. All isolates were identified by the conventional biochemical tests. Then, the antibiotic resistance of these isolates was determined using the disk diffusion method according to the CLSI guidelines. Also, the E.test was performed to determine the minimum inhibitory concentrations (MIC) of imipenem. The mutations of this gene were recognized by the amplification of this region and subsequently sequenced. Sequencing of the genomic region upstream of oprD these regions were done in the 29 clinical strains. Statistical analysis was done by the statistical software SPSS-18. Seventy (77.7%) of isolates had MIC ≥ 16 and were resistant to imipenem. Mutations of the upstream of the oprD gene and its promoters were seen in 25 (86.2%) isolates and 4 isolates had no mutation. One isolate had a base substitution A→Cat nt 25 in the coding region and this isolate had a point mutation leading to an amino acid change at positions 9 (I→L). Our study results indicated that none of the strains had mutation in Shine-Dalgarno and the point mutations were the most common mutations upstream of the oprD coding region among P. aeruginosa isolates. Mutations were observed in imipenem-resistant isolates and it seems this mechanism is effective in resistance of isolates to imipenem and this confirmed that the indiscriminate use of antibiotic should be controlled.

PMID:34089411 | DOI:10.1186/s13568-021-01243-3

Trop Anim Health Prod. 2021 Jun 5;53(3):342. doi: 10.1007/s11250-021-02782-4.

ABSTRACT

This study was designed to identify single-nucleotide polymorphisms (SNPs) of some candidate genes related to lipid metabolism and their association with carcass fat in male crossbred lambs. Hence, 96 of almost 11-month-old Booroola Merino-Afshari crossbred lambs (first-generation backcross) were used by considering their phenotypic carcass traits. Then, DNA was extracted and DNA targets were amplified using designed specific primers by PCR procedure. Identification of potential SNPs was done by a direct sequencing method for LEP, FABP4, DGAT1, GH, and TRIB3 genes using the sequencing-RFLP procedure. Then, the most probable statistical models based on additive and genotypic effects of identified SNPs in each trait were obtained by the Bayesian model averaging (BMA) approach of R software (Ver. 3.3.1) to assess the association of SNPs with traits. Detected SNPs in this study included two SNPs in exon 3 of LEP, one SNP in exon 2 of TRIB3, one SNP in intron 2 of FABP4, one SNP in 5′ UTR of DGAT1, and two SNPs in 3′ UTR of GH genes. For carcass weight trait, one of the identified SNP genotypes in the LEP (c.587G > A) had a higher probability in the model. Carcass weight of lambs with GA genotype was 2.46 kg heavier than GG genotype. Also, two genes of TRIB3 and GH2 had the highest probability in the models of fat tail and waste weight, respectively. Based on the results, these polymorphisms can be used in the marker-assisted selection of breeding programs and designing DNA chips for genomic selection.

PMID:34089397 | DOI:10.1007/s11250-021-02782-4

Arch Dermatol Res. 2021 Jun 5. doi: 10.1007/s00403-021-02248-5. Online ahead of print.

ABSTRACT

Patient satisfaction is an important consideration when determining the optimal treatment for non-melanoma skin cancer (NMSC). One critical aspect of patient satisfaction is post-procedural wound care quality of life (QOL), especially as the elderly population grows. This study aimed to evaluate post-procedural wound care QOL in elderly patients undergoing electrodessication and curettage (ED&C) for NMSC in difficult-to-reach areas, namely the posterior shoulder and back. To do so, patient demographics, functionality, co-morbidities, and post-procedural wound care QOL were assessed in twenty elderly patients (age > 65) who underwent ED&C for NMSC at a single academic dermatologic surgery clinic. Independent t-tests were used to evaluate how QOL related to patient age, gender, living situation, relationship status, co-morbidities, and functionality. Patients who lived alone had better-wound care QOL compared to patients who did not live alone (p = 0.04). Patients reported concerns about knocking the wound and did not feel they could care for the wound independently. Patients who were married, female, or had a lower comorbidity score reported poorer QOL, although this finding was not statistically significant. This study indicates that patients’ QOL can be negatively affected by post-procedural wounds located in difficult-to-reach areas. As dermatologists strive to improve patient satisfaction, wound care quality of life should be considered when choosing treatment for NMSC.

PMID:34089376 | DOI:10.1007/s00403-021-02248-5

Cancer Immunol Immunother. 2021 Jun 5. doi: 10.1007/s00262-021-02954-z. Online ahead of print.

ABSTRACT

We have previously revealed the overexpression of Wilms’ tumor gene 1 (WT1) in malignant glioma and developed WT1 peptide vaccine cancer immunotherapy. A phase II clinical trial indicated the clinical efficacy of the WT1 peptide vaccine for recurrent malignant glioma. Here, we aimed to investigate the immunological microenvironment in glioma tissues before and after WT1 peptide vaccine treatment. Paired tissue samples were obtained from 20 malignant glioma patients who had received the WT1 peptide vaccine for > 3 months and experienced tumor progression, confirmed radiographically and/or clinically, during vaccination. We discovered that the expression of WT1 and HLA class I antigens in the tumor cells significantly decreased after vaccination. Maintenance of WT1 expression, which is the target molecule of immunotherapy, in tumor cells during the vaccination period was significantly associated with a longer progression-free and overall survival. A high expression of HLA class I antigens and low CD4⁺/CD8⁺ tumor-infiltrating lymphocytes (TIL) ratio in pre-vaccination specimens, were also associated with a good prognosis. No statistically significant difference existed in the number of infiltrating CD3⁺ or CD8⁺ T cells between the pre- and post-vaccination specimens, whereas the number of infiltrating CD4⁺ T cells significantly decreased in the post-vaccination specimens. This study provides insight into the mechanisms of intra-tumoral immune reaction/escape during WT1 peptide vaccine treatment and suggests potential clinical strategies for cancer immunotherapy.

PMID:34089373 | DOI:10.1007/s00262-021-02954-z

Int Arch Occup Environ Health. 2021 Jun 5. doi: 10.1007/s00420-021-01721-y. Online ahead of print.

ABSTRACT

PURPOSE: Over the last few decades, a global increase in both cold and heat extremes has been observed with significant impacts on human mortality. Although it is well-identified that older individuals (> 65 years) are most prone to temperature-related mortality, there is no consensus on the effect of sex. The current study investigated if sex differences in temperature-related mortality exist in the Netherlands.

METHODS: Twenty-three-year ambient temperature data of the Netherlands were combined with daily mortality data which were subdivided into sex and three age classes (< 65 years, 65-80 years, ≥ 80 years). Distributed lag non-linear models were used to analyze the effect of ambient temperature on mortality and determine sex differences in mortality attributable to the cold and heat, which is defined as mean daily temperatures below and above the Minimum Mortality Temperature, respectively.

RESULTS: Attributable fractions in the heat were higher in females, especially in the oldest group under extreme heat (≥ 97.5th percentile), whilst no sex differences were found in the cold. Cold- and heat-related mortality was most prominent in the oldest age group (≥ 80 years) and to a smaller extent in the age group between 65-80 years. In the age group < 65 years temperature-related mortality was only significant for males in the heat.

CONCLUSION: Mortality in the Netherlands represents the typical V- or hockey-stick shaped curve with a higher daily mortality in the cold and heat than at milder temperatures in both males and females, especially in the age group ≥ 80 years. Heat-related mortality was higher in females than in males, especially in the oldest age group (≥ 80 years) under extreme heat, whilst in the cold no sex differences were found. The underlying cause may be of physiological or behavioral nature, but more research is necessary.

PMID:34089351 | DOI:10.1007/s00420-021-01721-y

Knee Surg Sports Traumatol Arthrosc. 2021 Jun 5. doi: 10.1007/s00167-021-06613-9. Online ahead of print.

ABSTRACT

PURPOSE: Current treatment recommendations emphasize early loading, with preservation of tendon length and physiologic tension. The objective of this systematic review and network meta-analysis was to compare failure load and elongation after cyclic loading of Achilles tendon repair techniques at time-zero.

METHODS: The databases PubMed, CENTRAL and Web of Science were searched for all published in-vitro studies comparing Achilles tendon repair techniques, or augmentation with autografts/biomaterials, and reports of failure load or elongation after cyclic loading. Only studies using human cadaveric Achilles tendons and matched pairs, or randomized specimen allocation, were selected for quantitative synthesis. A network meta-analysis per primary outcome was performed. Results were summarized as P score rankings and their validity was assessed using statistical methods.

RESULTS: Sixteen studies, comprising 367 tendon repairs, were included. The following repair techniques were used (n = number of studies): Krackow (n = 8), Achillon (n = 4), double Krackow (n = 3), Bunnell (n = 3), Percutaneous Achilles Repair System (n = 3), Percutaneous Achilles Repair System Midsubstance (n = 2), Kessler (n = 3), double Kessler (n = 1), modified triple Kessler (n = 1), triple bundle (n = 1), a multifilament stainless steel cable-crimp technique (n = 1) and a double loop knot stitch (n = 1). Five studies assessed augmentation with autografts/biomaterials. Regarding the failure load, biomaterial augmented Krackow repairs occupied the first four positions in the ranking, followed by the multifilament stainless steel cable-crimp and Percutaneous Achilles Repair System Midsubstance techniques. Concerning elongation after cyclic loading, the triple Kessler was ranked first, followed by the Achillon and Percutaneous Achilles Repair System Midsubstance techniques. A negligible correlation between ranks was found (r_s = 0.11; p = 0.75n.s.), meaning that a higher repair tensile strength is not necessarily related to improved performance in regard to avoidance of elongation.

CONCLUSION: In the failure load network meta-analysis, biomaterial augmented Krackow repairs ranked highest, but noticeable statistical heterogeneity was found. Regarding elongation with cyclic loading, the modified triple Kessler stitch showed the highest probability of ranking first.

LEVEL OF EVIDENCE: Level IV.

PMID:34089335 | DOI:10.1007/s00167-021-06613-9

Autism Res. 2021 Jun 5. doi: 10.1002/aur.2550. Online ahead of print.

ABSTRACT

Previous studies found associations between autism-related phenotypes and both rearing and V1A arginine vasopressin receptor (AVPR1A) genotypes. We tested whether these exposures as well as their interaction were associated with autism-related phenotypes in 121 laboratory-housed chimpanzees. We used expert-derived weights to obtain autism scores from ratings on the 43-item Chimpanzee Personality Questionnaire; higher scores indicated more autistic-like traits. The first model included fixed effects for sex, age, and rearing, and a random effect that addressed the relatedness of subjects. The second model was the same except that it also included the rearing × AVPR1A genotype interaction as a fixed effect. Both models indicated that the phenotype was moderately heritable and that chimpanzees reared by their mothers had lower scores on the scale. The effect of genotype in both models indicated that chimpanzees with an indel deletion had higher scores on the scale, although the credible interval included zero. Moreover, the rearing × genotype interaction in the second model indicated that chimpanzees who possessed the non-deletion genotype and who were reared by their mother were at even greater risk. The credible interval for this effect did not include zero, but fit statistics indicated that the model without the interaction was marginally better, and the interaction was in the opposite direction than we expected based on previous work. These findings highlight the importance of rearing effects in the typical social development of our closet-living nonhuman relative. LAY SUMMARY: We tested whether, in chimpanzees, scores on a scale comprising traits that resembled aspects of autism were related to a gene associated with autism in prior research and/or early rearing. Human-reared chimpanzees had higher scores (indicating more autistic-like traits). Chimpanzees that possessed the gene also had higher scores, but we could not exclude the possibility that there was no effect of genotype. These findings suggest that we can measure autism-like characteristics in chimpanzees, and so study it in this species.

PMID:34089305 | DOI:10.1002/aur.2550

Lipids. 2021 Jun 5. doi: 10.1002/lipd.12314. Online ahead of print.

ABSTRACT

Dyslipidemia is nephrotoxic and can result in the development of chronic kidney disease (CKD). The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) (TG/HDL-C ratio) is well-correlated with insulin resistance and cardiovascular events. The aim of this study is to examine the association between the TG/HDL-C ratio and CKD in Korean adults. This study was retrospectively designed based on the National Health Insurance Service-National Health Screening cohort. Seventy three thousand and fifty-two participants aged between 40 and 79 years old at baseline (2009-2010) were included in the final analyses. The study population was classified into three tertile groups (T₁ , T₂ , and T₃ ) according to the TG/HDL-C ratio by sex. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CKD were calculated using Cox proportional hazard regression models. The median follow-up duration was 5.9 years. Higher tertile groups of the TG/HDL-C ratio had lower estimated glomerular filtration rates in both sexes. The cumulative incidence of CKD of T₁ , T₂ , and T₃ was 11.89%, 12.90%, and 12.91%, respectively, in men and 10.17%, 10.61%, and 14.87%, respectively, in women (all p values < 0.001). Compared with T₁ of the TG/HDL-C ratio, the HRs (95% CIs) of T₂ and T₃ for CKD were 1.212 (1.118-1.315) and 1.183 (1.087-1.287), respectively, in men and 0.895 (0.806-0.994) and 1.038 (0.937-1.150), respectively, in women after being fully adjusted. Higher TG/HDL-C ratios were positively associated with CKD development in men, while middle levels of TG/HDL ratios reduced the CKD incidence in women.

PMID:34089267 | DOI:10.1002/lipd.12314

J Cosmet Dermatol. 2021 Jun 5. doi: 10.1111/jocd.14278. Online ahead of print.

ABSTRACT

BACKGROUND: Auricular melanomas are rare malignancies, and conflicting reports regarding their clinical behaviors have been published so far.

OBJECTIVE: In this study, we investigated the clinical features of the auricular melanomas and compared them with periauricular skin melanomas.

METHODS: The data of 53 primary melanomas arising in auricular (n=25) and periauricular regions (n=28) were analyzed retrospectively.

RESULTS: Demographic, histopathological and clinical characteristics were found similar in auricular and periauricular melanomas (p>0.05). Likewise, the recurrence rates for each group were found to be similar (30%) (p=0.9). The 5-year relapse-free survival rate of all patients was 57.4% and no statistical difference was observed between two groups; 63.9% for auricular melanomas and 51.7% for periauricular melanomas (p=0.5). Moreover, 5-year overall survival rate of all melanomas was 46.9%; and there was no statistical significance between two groups, 56.1% and 37.4% for auricular and periauricalar melanomas, respectively (p=0.4).

CONCLUSION: Auricular and periauricular melanomas share similar clinicopathological features and outcomes.

PMID:34089217 | DOI:10.1111/jocd.14278