Tag: nevin manimala

Int J Immunogenet. 2022 Nov 3. doi: 10.1111/iji.12606. Online ahead of print.

ABSTRACT

Endometriosis is an inflammatory disease characterized by the presence of ectopic endometrial tissue, immune cell dysfunction and abnormal cytokine secretion. In addition to immunological factors, genetic variations that influence endometriosis severity and cytokine expression levels play important roles in the pathogenesis of this disease. Interleukin-12 (IL-12), specifically its p40 subunit encoded by IL-12B gene and the interleukin-12 receptor β1 (IL-12Rβ2) chain of its receptor, as well as interleukin-27 (IL-27) are important in the establishment of endometriosis. So, in this study, we measured IL-12 and IL-27 serum levels and investigated the possible links between IL-12B rs3212227, IL-12Rβ2 rs3790565 and IL-27 rs153109 polymorphisms and the risk of developing endometriosis in a group of Iranian women. In this case-control study, 162 endometriosis patients and 151 healthy women were included and tested for the aforementioned polymorphisms using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The enzyme-linked immunosorbent assay (ELISA) method was also used to measure IL-12 and IL-27 serum levels. Although there was no statistically significant association between the genotypes and alleles of the studied polymorphisms and the development of endometriosis in general, the AA genotype of IL-12B rs3212227 showed a significant association with uterine endometriosis when compared to AC+CC genotypes (p = .04, CI = 0.270-0.988, OR = 0.517). Indeed, the AA genotype of the IL-12B rs3212227 single nucleotide polymorphism (SNP) may be linked with a lower risk of developing uterine endometriosis. There was no significant difference in IL-27 levels between the two studied groups (p = .49), and IL-12 levels were undetectable in both groups. In conclusion, the AA genotype of IL-12B rs3212227 might be associated with a decreased risk of uterine involvement in endometriosis patients.

PMID:36328955 | DOI:10.1111/iji.12606

J Plast Reconstr Aesthet Surg. 2022 Oct 15:S1748-6815(22)00569-1. doi: 10.1016/j.bjps.2022.10.019. Online ahead of print.

ABSTRACT

Anecdotally, female plastic surgeons are disproportionately underrepresented as speakers, moderators, and panelists at national and regional plastic surgery meetings. No studies have attempted to quantify female representation at Plastic Surgery The Meeting (PSTM). The objective of our study is to examine trends in female participation at PSTM. Names of participating plastic surgeons and their conference positions were obtained from PSTM meeting programs between 2015-2020. Conference positions included instructor, lead, lecturer, moderator, panelist, or other. Presentations were grouped as the following: conference/symposium; general session; instructional course; and lab. An automated gender assignment tool (gender-api.com) was used to determine the gender of participants. Descriptive statistics and trend analyses using Cochran-Armitage trend tests were performed. Between 2015-2020, 3,382 individuals (602 females, 17.8%) presented at PSTM in one of the instructional or moderating roles. Female presenters at PSTM increased from 60 (12.4%) in 2015, to 155 (26.5%) by 2020. The results for the proportion of females presenting in the general session and the instructional courses were statistically significant (p < .0001; p =.029), demonstrating a positive linear trend in the female proportions over the years. From 2015 to 2020, the proportions of females holding positions as moderators, panelists, and “other” increased significantly (p = .011; p = .011; p < .0001). Although female participation at PSTM has shown substantial growth over the last five years, there still exists a considerable gender imbalance. Notably, females were less likely to hold prominent positions, such as instructors, leads, or lecturers.

PMID:36328946 | DOI:10.1016/j.bjps.2022.10.019

J Surg Educ. 2022 Oct 31:S1931-7204(22)00259-8. doi: 10.1016/j.jsurg.2022.10.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Traditionally, the Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to implement research and other scholarly activities into their training curriculum. Encouraging residents to publish during residency is believed to promote research throughout their careers; however, the rate of research outcomes among general surgery residents remains unknown. Our study aims to determine associated factors that influence publication rates before, during, and after general surgery residency.

METHODS: This observational study employed a cross-sectional design. We examined whether research outcomes during general surgery residency was associated with academic advancement or continued research involvement after residency. We identified 321 general surgery residency programs on the Doximity website and randomly selected 50 to include in our sample. Of these programs, graduate rosters for 31 programs were located and subsequently included. Of the 405 residency graduates identified, we recorded the number of peer-reviewed publications, H-indices, fellowships, and whether the graduate pursued a career in private practice or academia.

RESULTS: Among the 405 physicians analyzed, 3815 total publications were identified with a mean of 9.4 (SD 11.8) per person. The most reported study design was observational studies (46.5%; 1775/3815) and the least reported was systematic reviews/meta-analyses (1.4%; 52/3815). The number of publications before residency positively correlated with having a higher h-index (r = 0.4). We also found that physicians who completed a fellowship had more publications during residency (mean = 4.7, SD = 6.5) than those not pursuing a fellowship (mean = 1.5, SD = 2.7; t= -4.3. p ≤ 0.001). We observed a statistically significant increase in the likelihood a physician pursued a career in academic medicine if they pursued a fellowship (OR: 3.77, 95% CI: 2.0-7.2) and if they had published research as a primary author (OR 1.25, 95% CI: 1.0-1.5).

CONCLUSION: Increased research productivity was associated with continued academic pursuits and an increased likelihood of pursuing fellowship training after residency.

PMID:36328936 | DOI:10.1016/j.jsurg.2022.10.004

Eur Urol Oncol. 2022 Oct 31:S2588-9311(22)00174-2. doi: 10.1016/j.euo.2022.10.004. Online ahead of print.

ABSTRACT

BACKGROUND: There is a paucity of data on the safety of cabozantinib use in combination with radiotherapy.

OBJECTIVE: To report the practice patterns, safety, and efficacy of cabozantinib with radiotherapy in metastatic renal cell carcinoma (mRCC).

DESIGN, SETTING, AND PARTICIPANTS: An international multicenter retrospective study was conducted. Patients with mRCC treated with cabozantinib at any line of therapy and who received radiotherapy between 30 d prior to the start date of cabozantinib and 30 d following discontinuation of cabozantinib, from 2014 to 2020, were included. Concurrent use was defined as the use of cabozantinib on radiotherapy treatment days during any course of radiotherapy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcomes of interest were the rate of grade ≥3 adverse events (AEs) occurring within 90 d of receipt of radiotherapy. Secondary outcomes included hospitalization rate and patterns of cabozantinib and radiotherapy use. Baseline characteristics and AEs were presented descriptively.

RESULTS AND LIMITATIONS: A total of 127 consecutive patients were included. Most patients had clear cell histology (88%), had International Metastatic Renal Cell Carcinoma Database Consortium intermediate-risk disease (57%), and had received at least one prior line of therapy (93%). Of 127 patients, 67 (53%) received concurrent cabozantinib with radiotherapy, while the remaining held cabozantinib on radiotherapy days. Overall, grade 3-4 AEs occurred in 6.3% (n = 8/127) of patients. No grade 5 events were observed. In patients treated with conventional palliative radiotherapy (n = 88), the rate of grade 3-4 AEs in those who had concurrent versus those who had nonconcurrent cabozantinib was 6.3% (n = 3/48) versus 5.0% (n = 2/40). No patient was hospitalized due to radiotherapy-related toxicity. In patients treated with stereotactic ablative body radiotherapy (SABR; n = 50), the rate of grade 3-4 AEs in those who had concurrent versus those who had nonconcurrent cabozantinib was 3.6% (n = 1/28) versus 9.1% (n = 2/22). One patient in the nonconcurrent group was hospitalized due to muscle weakness suspected to be related to associated vasogenic edema 19 d after SABR for multiple brain metastases.

CONCLUSIONS: In this real-world study of patients with mRCC treated with cabozantinib, 53% of patients received radiotherapy concurrently, with few grade 3-4 AEs reported within 90 d of receiving radiotherapy. The use of radiotherapy and cabozantinib requires a risk-benefit assessment of patient and disease characteristics to optimize therapy regimens.

PATIENT SUMMARY: Our study reports the real-world experience of using radiotherapy in patients receiving cabozantinib for metastatic kidney cancer. Over half of the patients continued taking cabozantinib while receiving radiotherapy, and few patients developed serious side effects. The combined use of radiotherapy and cabozantinib requires a careful risk-benefit assessment to achieve optimal treatment outcomes.

PMID:36328934 | DOI:10.1016/j.euo.2022.10.004

J Foot Ankle Surg. 2022 Sep 28:S1067-2516(22)00269-1. doi: 10.1053/j.jfas.2022.09.005. Online ahead of print.

ABSTRACT

Calcaneus fracture fixation is associated with high rates of morbidity and disability from wound complications, infection, subtalar arthritis, and malunion. Percutaneous fixation with Kirshner wires (K-wires) or screws may be implemented when soft tissue injury precludes an open approach. Although screws are thought to provide greater stability, limited data exists directly comparing fixation success of these implants. Medical record data from 53 patients (62 total fractures) surgically treated with percutaneous screws (28 fractures) or K-wires (34 fractures) for joint-depression calcaneus fractures at a large tertiary hospital were retrospectively reviewed. Bohler’s angle and calcaneal varus were assessed from available radiographs at time of injury, postoperatively, and at final follow-up, and joint congruity was assessed postoperatively and at final follow-up. Complications were also extracted. There were no statistical differences in patient characteristics between surgical groups although a higher proportion of patients treated with K-wires compared to screws had other associated injuries (79% vs 42%, p = .01). A higher proportion of fractures treated with screws compared to K-wires maintained joint congruity at the final follow-up (69% vs 32%, p = .005). However, there were no statistically detectable differences in other postoperative radiographic metrics (p > .05). In conclusion, joint congruity was more often maintained with screw fixation although there was no statistical difference in restoration and maintenance of Bohler’s angle or varus alignment. The difference in radiographic metrics was not correlated with secondary procedures, namely subtalar arthrodesis, and may not be clinically significant. Neither group was completely effective in attaining and maintaining reduction, and additional fixation strategies should be considered if feasible based on patient, injury, and soft tissue characteristics.

PMID:36328917 | DOI:10.1053/j.jfas.2022.09.005

Am J Orthod Dentofacial Orthop. 2022 Oct 31:S0889-5406(22)00647-3. doi: 10.1016/j.ajodo.2021.10.021. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study was to explore the effect of augmented corticotomy (AC) on anterior alveolar bone morphology in presurgical orthodontic treatment for skeletal Class III malocclusion.

METHODS: Thirty-six surgical patients with skeletal Class III malocclusion with high-angle were included: 18 (AC group) accepted AC surgery during presurgical orthodontic treatment, and 18 (control group) accepted traditional presurgical orthodontic treatment. Cone-beam computed tomography scans were obtained before treatment (T0) and after presurgical orthodontic treatment (T1). The alveolar bone morphology, root length, dehiscence, and movement of mandibular central incisors were measured by cone-beam computed tomography using Dolphin software. Statistical analyses were performed with independent-sample t tests, paired t tests, and multiple linear regression.

RESULTS: After presurgical orthodontic treatment, the whole alveolar bone thickness at each level, alveolar bone area, and alveolar bone height decreased significantly in the control group but increased or remained unchanged in the AC group. In the AC group, the lower the labial alveolar bone height at T0 was, the greater the increase after T1; the change in alveolar bone thickness was related to ΔL1-MP and sex. At T0, the incidences of dehiscence were similar in the 2 groups, ranging from 11.11% to 16.67%. At T1, the labial and lingual incidences of dehiscence in the AC group were 0% and 27.78%, compared with 55.56% and 66.67% in the control group.

CONCLUSIONS: During presurgical orthodontic treatment, AC is effective in preventing alveolar bone resorption and dehiscence without additional root resorption. AC can be recommended for high-angle skeletal Class III patients with thin alveolar bone around anterior teeth during presurgical orthodontic treatment.

PMID:36328904 | DOI:10.1016/j.ajodo.2021.10.021

JACC Clin Electrophysiol. 2022 Oct 21:S2405-500X(22)00846-5. doi: 10.1016/j.jacep.2022.09.020. Online ahead of print.

ABSTRACT

BACKGROUND: There is limited evidence guiding the selection between subcutaneous and transvenous implantable cardioverter-defibrillators (ICDs) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) at risk for sudden death.

OBJECTIVES: This study aimed to compare clinical and quality-of-life outcomes between transvenous and subcutaneous ICDs among patients with ARVC.

METHODS: Patients with a subcutaneous ICD (n = 57) were matched to patients with a transvenous ICD (n = 88) based on sex, proband status, primary prevention or secondary prevention, monomorphic ventricular tachycardia before implantation, and year of implantation. Appropriate therapy for ventricular arrhythmia, inappropriate shocks, and complications were compared. Quality-of-life surveys were conducted annually.

RESULTS: The matched cohort (median age of 35 years, 43% men, 78% proband, and 37% secondary prevention device) were prospectively followed for 5.1 ± 2.5 years. No significant difference was observed in the rate of appropriate ICD shocks. The subcutaneous group had more inappropriate shocks (23% vs 10%) and fewer procedure-related complications (4% vs 14%) than the transvenous group (P < 0.05). The association between ICD type and the composite of inappropriate shock and complication was not statistically significant (subcutaneous vs transvenous adjusted HR: 1.43; 95% CI: 0.72-2.84). A subcutaneous ICD was associated with more body image concerns and range of motion than a transvenous ICD (P < 0.05).

CONCLUSIONS: In patients with ARVC receiving an ICD, the risk of inappropriate shocks from a subcutaneous ICD should be balanced against the significant vascular complication risk from a transvenous ICD. Patients with a subcutaneous ICD had more concerns for body image and range of motion.

PMID:36328892 | DOI:10.1016/j.jacep.2022.09.020

Vaccine. 2022 Oct 26:S0264-410X(22)01303-2. doi: 10.1016/j.vaccine.2022.10.043. Online ahead of print.

ABSTRACT

The mass vaccination program has been actively promoted since the end of 2020. However, waning immunity, antibody-dependent enhancement (ADE), and increased transmissibility of variants make the herd immunity untenable and the implementation of dynamic zero-COVID policy challenging in China. To explore how long the vaccination program can prevent China at low resurgence risk, and how these factors affect the long-term trajectory of the COVID-19 epidemics, we developed a dynamic transmission model of COVID-19 incorporating vaccination and waning immunity, calibrated using the data of accumulative vaccine doses administered and the COVID-19 epidemic in 2020 in mainland China. The prediction suggests that the vaccination coverage with at least one dose reach 95.87%, and two doses reach 77.92% on 31 August 2021. However, despite the mass vaccination, randomly introducing infected cases in the post-vaccination period causes large outbreaks quickly with waning immunity, particularly for SARS-CoV-2 variants with higher transmissibility. The results showed that with the current vaccination program and 50% of the population wearing masks, mainland China can be protected at low resurgence risk until 8 January 2023. However, ADE and higher transmissibility for variants would significantly shorten the low-risk period by over 1 year. Furthermore, intermittent outbreaks can occur while the peak values of the subsequent outbreaks decrease, indicating that subsequent outbreaks boosted immunity in the population level, further indicating that follow-up vaccination programs can help mitigate or avoid the possible outbreaks. The findings revealed that the integrated effects of multiple factors: waning immunity, ADE, relaxed interventions, and higher variant transmissibility, make controlling COVID-19 challenging. We should prepare for a long struggle with COVID-19, and not entirely rely on the COVID-19 vaccine.

PMID:36328883 | DOI:10.1016/j.vaccine.2022.10.043

Actas Urol Esp (Engl Ed). 2022 Jul 27:S2173-5786(22)00069-5. doi: 10.1016/j.acuroe.2022.07.001. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVE: The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival.

PATIENTS AND METHOD: Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p).

RESULTS: Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp=0.018), preservation of puboprostatic ligaments (adjp=0.02), preservation of endopelvic fascia (adjp=0.001) and performing periurethral suspension (adjp<0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp=0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance.

CONCLUSIONS: The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival.

PMID:36328875 | DOI:10.1016/j.acuroe.2022.07.001

Eur J Intern Med. 2022 Oct 31:S0953-6205(22)00378-8. doi: 10.1016/j.ejim.2022.10.020. Online ahead of print.

ABSTRACT

BACKGROUND: Risk-stratification of patients has a major role in the prevention and treatment of cardiovascular disease. The aim was to find the most informative predictors of cardiovascular events in patients undergoing Coronary CT Angiography.

METHODS: We carried out a secondary analysis of a large registry dataset. The included population comprises adults aged 18 or older who underwent Coronary CT Angiography of 64-detector rows or greater. We clustered patients based on their characteristics and compared the risk for poor clinical outcomes between the two clusters.

RESULTS: There were two clusters of patients having different risks for all-cause death, myocardial infarction, and late revascularization [hazard ratios (95%CI) = 2.28 (2.02, 2.57), 1.63 (1.40, 1.89), and 2.46 (2.1, 2.88), all P < 0.001]. The severity of stenosis in the left main coronary artery adjusted for age and sex was the most significant predictor of the high-risk cluster [adjusted odds ratio (95%CI) = 3.35 (2.98, 3.77), P < 0.001]. The severity of stenosis in the first obtuse marginal branch of the left circumflex, distal left circumflex, distal left anterior descending, posterior descending, the first diagonal branch of the left anterior descending, and proximal right coronary artery were important as well (all adjusted odds ratios ≥ 2.52). Cluster profiling showed a higher performance for CT Angiography features (sensitivity = 97.4%, specificity = 85.7%, C-statistic = 98.7%) than calcium, Framingham, and Duke scores in identifying high-risk patients (C-statistic = 82.1, 77.0, and 88.2%, respectively).

CONCLUSION: Coronary CT Angiography can accurately risk-stratify patients concerning poor clinical outcomes.

PMID:36328870 | DOI:10.1016/j.ejim.2022.10.020