Tag: nevin manimala

Arthroscopy. 2023 Aug 25:S0749-8063(23)00679-5. doi: 10.1016/j.arthro.2023.08.025. Online ahead of print.

ABSTRACT

PURPOSE: To review cadaveric studies evaluating the biomechanical outcomes of superior capsular reconstruction (SCR) with different graft types for the treatment of irreparable rotator cuff tears (RTC tears).

METHODS: PubMed, Cochrane, and Embase were queried in January 2022 to conduct this meta-analysis using the following keywords: “superior capsule reconstruction,” “superior capsular reconstruction,” and “biomechanics.” Articles were included if they reported glenohumeral superior translation or subacromial contact pressure following SCR in cadaveric RTC tears. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Number of shoulders, graft types, and biomechanical outcomes were recorded and analyzed with forest plots.

RESULTS: Twelve studies (95 shoulders) were included in the statistical analysis. There was a significant reduction in glenohumeral superior translation following SCR compared to RTC tear across 10 studies (79 shoulders) with standardized mean difference (SMD) -2.48mm [-3.28mm, -1.69mm]. The SMD between fascia lata graft and RTC tear was -3.84mm [-4.82mm, -2.86mm] and between dermal allograft and RTC tear was -2.05mm [-3.10mm, -1.00mm]. There was a significant reduction in subacromial contact pressure following SCR compared to RTC tear across 5 studies (55 shoulders) with SMD -3.49 MPa [-4.54 MPa, -2.44 MPa]. The SMD between fascia lata graft and RTC tear was -3.21 MPa [-5.08 MPa, -1.34 MPa] and between dermal allograft and RTC tear was -3.89 MPa [-5.91 MPa, -1.87 MPa].

CONCLUSION: Independent of graft type, biomechanical studies suggest that SCR improves glenohumeral superior translation and subacromial contact pressure in comparison to RTC tear at time zero. There was no definitive evidence identified in this study to suggest a biomechanically superior SCR graft option.

CLINICAL RELEVANCE: Investigating the biomechanical outcomes of several graft types for superior capsular reconstruction will help surgeons better understand the efficacies of different graft types for use in superior capsule reconstruction surgery.

PMID:37634706 | DOI:10.1016/j.arthro.2023.08.025

J Clin Epidemiol. 2023 Aug 25:S0895-4356(23)00216-0. doi: 10.1016/j.jclinepi.2023.08.011. Online ahead of print.

ABSTRACT

OBJECTIVE: Preprints became a major source of research communication during the COVID-19 pandemic. We aimed to evaluate whether summary treatment effect estimates differ between preprint and peer-reviewed journal trials.

STUDY DESIGN AND SETTING: A meta-epidemiological study. Data were derived from the COVID-NMA living systematic review (covid-nma.com) up to July 20, 2022. We identified all meta-analyses evaluating pharmacological treatments vs. standard of care/placebo for patients with COVID-19 that included at least one preprint and one peer-reviewed journal article. Difference in effect estimates between preprint and peer-reviewed journal trials were estimated by the ratio of odds ratio (ROR); ROR < 1 indicated larger effects in preprint trials.

RESULTS: Thirty-seven meta-analyses including 114 trials (44 preprints, 70 peer-reviewed publications) were selected. The median number of RCTs per meta-analysis was 2 (IQR, 2-4; maximum, 11), median sample size of RCTs was 199 (IQR, 99-478). Overall, there was no statistically significant difference in summary effect estimates between preprint and peer-reviewed journal trials (ROR, 0.88; 95% CI, 0.71-1.09; I2 = 17.8%; τ2= 0.06).

CONCLUSION: We did not find an important difference between summary treatment effects of preprints and summary treatment effects of peer-reviewed publications. Systematic reviewers and guideline developers should assess preprint inclusion individually, accounting for risk of bias and completeness of reporting.

PMID:37634703 | DOI:10.1016/j.jclinepi.2023.08.011

J Stroke Cerebrovasc Dis. 2023 Aug 25;32(10):107252. doi: 10.1016/j.jstrokecerebrovasdis.2023.107252. Online ahead of print.

ABSTRACT

OBJECTIVES: Given Mediterranean-style diet (MeDi) reduces risk of cardiovascular events, we hypothesized MeDi may also be protective against intracranial large artery stenosis (ICAS), a common cause of stroke worldwide.

METHODS: This cross-sectional study included stroke-free participants of the Northern Manhattan Study, a diverse population-based study of stroke risk factors. We represented MeDi continuously (range 0-8) based on enrollment food frequency questionnaires, excluding alcohol consumption. We evaluated ICAS both dichotomously at clinically relevant stenosis severities and continuously as a score (possible range 0-44), summated from stenosis severity scores of major intracranial arteries from time-of-flight magnetic resonance angiography. We used logistic or zero-inflated Poisson regression, adjusting for key confounders.

RESULTS: Among 912 included participants (mean age 64±8 years, 59% female, 65% Hispanic, mean MeDi score 4±1.5), 5% and 8% of participants had ≥50% or ≥70% ICAS, respectively (score median [interquartile range]: 0 [0-2]). Increased MeDi score was inversely associated with ICAS, but did not reach statistical significance (≥50% stenosis odds ratio (OR) [95% confidence interval (CI)]: 0.89 [0.79-1.06]; ≥70% stenosis OR [95% CI]: 0.91 [0.74-1.13]; stenosis score β-estimate [95% CI]: -0.02 [-0.06-0.01]).

CONCLUSION: In this stroke-free subsample, we did not find a significant association between MeDi and ICAS. We may have been limited by statistical power.

PMID:37634256 | DOI:10.1016/j.jstrokecerebrovasdis.2023.107252

Psychiatr Pol. 2023 Jun 11:1-15. doi: 10.12740/PP/OnlineFirst/162574. Online ahead of print.

ABSTRACT

OBJECTIVES: The emotional reactions of therapist in the treatment process constitute the core of therapeutic work, but they are poorly represented in research area. The article presents the results of work on the creation of a new tool the Questionnaire for the Perception of Psychotherapy Process by the Psychotherapist (QPPP).

METHODS: The Questionnaire containing 267 statements assessing cognitive, affective and behavioural reactions of psychotherapists in interaction with a specific patient was uploaded on the website. The link to the website, together with a request to complete the questionnaire, was sent to the members of the Psychotherapeutic Societies. The study involved 159 therapists, working mainly psychodynamically (91.95%). The analysis of basic descriptive statistics of test items and exploratory factor analysis by principal components method with varimax rotation were used.

RESULTS: The work resulted in creating a tool consisting of 75 items grouped into 6 scales: Positive cooperation with the patient, Therapist burdened with commitment, Therapist in the centre of negative interest, Therapist with no room for intervention, The overwhelmed/overloaded therapist, The helpless/disengaged therapist. High alpha-Cronbach reliability of all distinguished factors was demonstrated at the level from 0.79 to 0.94. The data analysis also made it possible to create initial sten standards for therapists working in the psychodynamic approach.

CONCLUSIONS: A tool was developed to assess emotions of therapist in relation to client. QPPP contains generally understandable terminology, independent of the therapist’s dominant modality. The questionnaire can have many practical applications – both scientific and clinical.

PMID:37634252 | DOI:10.12740/PP/OnlineFirst/162574

Scand J Work Environ Health. 2023 Aug 27:4116. doi: 10.5271/sjweh.4116. Online ahead of print.

ABSTRACT

OBJECTIVE: Occupational ergonomic factors (OEF) include physical exertion, demanding posture, repetitive work, hand-arm vibration, kneeling or squatting, rising, and climbing, which are risk factors for low-back pain (LBP). This study aimed to examine the prevalence, years lived with disability (YLD), healthcare costs, and productivity losses of LBP attributable to OEF by age, sex, World Health Organization region, and country in 2019.

METHODS: In this cross-sectional study, prevalence and YLD were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Employment statistics were obtained from the International Labor Organization websites. Health and economic impact was estimated for 192 countries and territories using the population attributable fraction method.

RESULTS: Globally, OEF were responsible for 126.1 million prevalent cases of LBP and 15.1 million YLD in the working-age population (aged 15-84 years) in 2019, with the Western Pacific region suffering most. OEF-attributable LBP led to $216.1 billion of economic losses worldwide. Of these, $47.0 billion were paid in healthcare costs, with the public sector serving as the largest contributor (59.2%). High-income countries bore >70% of global economic burden, whereas middle-income countries experienced >70% of global YLD. Generally, more prevalent cases and healthcare costs were found among females, whereas more YLD, productivity losses, and total costs were found among males.

CONCLUSIONS: Globally, OEF-attributable LBP presented a heavy burden on health and economic systems. Exercise together with education, active monitoring, evidence-based medical practices, alternative cost-effective solutions, and prioritizing health policies are needed.

PMID:37634250 | DOI:10.5271/sjweh.4116

Iran J Kidney Dis. 2023 Jul;17(4):222-227.

ABSTRACT

NTRODUCTION: Hyperhomocysteinemia is an important risk factor for cardiovascular disease in ESKD patients. Homocysteine, as an inflammatory factor, and carotid intima-media thickness (CIMT) could predict atherosclerosis in hemodialysis-treated ESKD patients. In this regard, the present study was conducted to investigate serum homocysteine level and its relationship with internal carotid intima thickness in ESKD patients undergoing routine hemodialysis.

METHODS: This study comprised 56 ESKD patients, older than 40 years, undergoing hemodialysis for at least 1 year. All participants were taking Nephrovit for at least 6 months. The study participants were patients who underwent ultrasonography for CIMT determination and laboratory test Results. There was no statistically significant relationship between the mean homocysteine level and hypertension, diabetes mellitus, duration of dialysis, and body mass index (BMI). Among the study participants, the results also showed that the mean value of CMIT homocysteine and C-reactive protein (CRP) were 0.89 millimeters, 30.44 (mcmol/L), and 35.60 mg/L; respectively. Despite hypertension, there was a significant difference between the mean values of CMIT in patients with diabetes mellitus and those who had been on dialysis for a longer period (more than 3 years). Also, the mean value of CMIT was significantly higher in obese patients than those with normal BMI. None of the other variables including homocysteine serum level, C-reactive protein (CRP), and CMIT showed a significant correlation.

CONCLUSION: The results of the study suggest that there is no relationship between serum homocysteine level and carotid intima-media thickness in hemodialysis patients. DOI: 10.52547/ijkd.7424.

PMID:37634249

Clin Exp Med. 2023 Aug 27. doi: 10.1007/s10238-023-01144-8. Online ahead of print.

ABSTRACT

AIMS: To explore the cardiac safety of adjuvant Non-Pegylated Liposomal Doxorubicin (NPL-DOX) plus Cyclophosphamide (CTX) followed by weekly Paclitaxel, in elderly women (≥ 65 years) with high-risk breast cancer. Previously, we described no symptomatic cardiac events within the first 12 months from starting treatment. We now reported the updated results after a median follow-up 76 months.

METHODS: The cardiac activity was evaluated with left ventricular ejection fraction (LVEF) echocardiograms assessments, before starting chemotherapy and every 6 months, until 30 months from baseline, then yearly for at least 5 years.

RESULTS: Forty-seven women were recruited by two Units of Medical Oncology (Ethics Committee authorization CESM-AOUP, 3203/2011; EudraCT identification number: 2010-024067-41, for Pisa and Pontedera Hospitals). An episode of grade 3 CHF (NCI-CTCAE, version 3.0) occurred after 18 months the beginning of chemotherapy. The echocardiograms assessments were performed comparing the LVEF values of each patient evaluated at fixed period of time, compared to baseline. We observed a slight changed in terms of mean values at 48, 60, 72 and 84 months. At these time points, a statistically significant reduction of – 3.2%, – 4.6%, – 6.4% and – 7.1%, respectively, was observed. However, LVEF remained above 50% without translation in any relevant clinical signs. No other cardiac significant episodes were reported. To this analysis, in 13 patients (28%) occurred disease relapse and, of them, 11 (23%) died due to metastatic disease. Eight patients died of cancer-unrelated causes.

CONCLUSIONS: The combination including NPL-DOX in elderly patients revealed low rate of cardiac toxic effects. Comparative trials are encouraged.

PMID:37634231 | DOI:10.1007/s10238-023-01144-8

J Cancer Res Clin Oncol. 2023 Aug 27. doi: 10.1007/s00432-023-05305-w. Online ahead of print.

ABSTRACT

PURPOSE: The MGMT (O⁶-methylguanine-DNA methyltransferase) gene plays a crucial role in repairing DNA damage caused by alkylating agents, including those used in chemotherapy. Genetic and epigenetic alterations can influence the regulation of MGMT gene, which in turn may impact the response to concomitant chemoradiotherapy (CRT) in cervical cancer. The present study was undertaken to evaluate the correlation of such variations in MGMT gene with the treatment outcome of concomitant chemoradiotherapy (CRT) in cervical cancer.

METHODS: A total of 460 study subjects (240 controls and 220 patients) were subjected to genotypic analysis of MGMT gene variants rs12917(T/C) and rs2308327(A/G) by Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS-PCR). Out of them, 48 each of controls and patients were analyzed for promoter methylation and expression by methylation-specific PCR and real-time PCR, respectively. Patients (n = 48) were followed up and evaluated for treatment (CRT) outcome. Statistical analyses were done using GraphPad (9.0) and SPSS version 18.0.

RESULTS: Individuals with GG genotype, G allele of rs2308327, and haplotype ‘TA’ of both variants showed a significant increase in the development of cervical cancer (P ≤ 0.05). In epigenetic regulation, there was a significant hypermethylation of MGMT gene and down-regulation of their expression in patients compared to control individuals. In treatment outcome of CRT, GG genotype of rs2308327(A/G) gene variant showed better response and GG + AG was significantly associated with vital status (alive). Unmethylated MGMT gene showed better median overall survival up to 25 months significant in comparison to methylated MGMT promoter.

CONCLUSION: Gene variant rs2308327(A/G) and promoter hypermethylation regulated MGMT gene can be a good prognostic for treatment response in cervical cancer patients.

PMID:37634205 | DOI:10.1007/s00432-023-05305-w

Circulation. 2023 Aug 27. doi: 10.1161/CIRCULATIONAHA.123.066498. Online ahead of print.

ABSTRACT

Background: Computed tomography (CT) is recommended for guiding transcatheter aortic valve replacement (TAVR). However, as a sizable proportion of TAVR candidates have chronic kidney disease (CKD), the use of iodinated contrast media is a limitation. Cardiac magnetic resonance (CMR) is a promising alternative, yet randomized data comparing the effectiveness of CMR- versus CT-guided TAVR are lacking. Methods: An investigator-initiated, prospective, randomized, open-label, non-inferiority trial was conducted at two Austrian heart centers. Patients evaluated for TAVR according to the inclusion (severe symptomatic aortic stenosis) and exclusion criteria (contraindication to CMR, CT, or TAVR, a life expectancy < 1 year, CKD 4 or 5) were randomized (1:1) to undergo CMR- or CT-guiding. The primary outcome was defined according to the Valve Academic Research Consortium-2 definition of implantation success at discharge, including absence of procedural mortality, correct positioning of a single prosthetic valve, and proper prosthetic valve performance. Non-inferiority was assessed using a hybrid modified intention-to-treat (mITT)/per-protocol (PP) approach based on an absolute risk difference margin of 9%. Results: Between September 11, 2017, and December 16, 2022, 380 candidates for TAVR were randomized to CMR-guided (191 patients) or CT-guided (189 patients) TAVR planning. Of these, 138 patients (72.3%) in the CMR-guided group and 129 patients (68.3%) in the CT-guided group eventually underwent TAVR (mITT cohort). Of these 267, 19 patients had protocol deviations, resulting in a PP cohort of 248 patients (n=121 CMR-guided, n=127 CT-guided). In the mITT cohort, implantation success was achieved in 129 patients (93.5%) in the CMR group and in 117 patients (90.7%) in the CT group (between-group difference, 2.8%; 90% confidence interval [CI]: -2.7 to 8.2%; p<0.01 for non-inferiority). In the PP cohort (n=248), the between-group difference was 2.0% (90% CI: -3.8 to 7.8%; p<0.01 for non-inferiority). Conclusions: CMR-guided TAVR was non-inferior to CT-guided TAVR in terms of device implantation success. CMR can therefore be considered as an alternative for TAVR planning.

PMID:37634187 | DOI:10.1161/CIRCULATIONAHA.123.066498

Dig Dis Sci. 2023 Aug 27. doi: 10.1007/s10620-023-08078-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Peptic ulcers with adherent clots are associated with a high-risk of rebleeding and mortality. However, the optimal management of bleeding ulcers with adherent clots remains unclear. We conducted this systematic review and meta-analysis to compare endoscopic therapy and conservative therapy to manage bleeding ulcers with adherent clots.

METHODS: We systematically searched PubMed, Embase, and Web of Science databases through October 2022 to include all studies comparing the endoscopic and conservative therapeutic approaches for bleeding ulcers with adherent clots. Our primary outcome was rebleeding (overall and 30-day). The secondary outcomes were mortality (overall and 30-day), need for surgery, and length of hospital stay (LOS). The random-effects model was used to calculate the pooled odds ratios (OR) and mean differences (MD) with the corresponding confidence intervals (CI) for proportional and continuous variables, respectively.

RESULTS: Eleven studies (9 RCTs) with 833 patients (431 received endoscopic therapy vs. 402 received conservative therapy) were included. Overall, endoscopic therapy was associated with lower overall rebleeding (OR 0.41, 95% CI 0.22-0.79, P = 0.007), 30-day rebleeding (OR 0.43, 95% CI 0.21-0.89, P = 0.002), overall mortality (OR 0.47, 95% CI 0.23-0.95, P = 0.04), 30-day mortality (OR 0.43, 95% CI 0.21-0.89, P = 0.002), need for surgery (OR 0.44, 95% CI 0.21-0.95, P = 0.04), and LOS (MD – 3.17 days, 95% CI – 4.14, – 2.19, P < 0.00001). However, subgroup analysis of randomized controlled trials (RCTs) showed no significant difference in overall mortality (OR 0.78, 95% CI 0.24-2.52, P = 0.68) between the two strategies, with numerically lower but statistically non-significant rates of overall rebleeding (7.2% vs. 18.5%, respectively; OR 0.42, 95% CI 0.17-1.05, P = 0.06), statistically lower rate of need for surgery (OR 0.28, 95% CI 0.08-0.96, P = 0.04) with endoscopic therapy compared to conservative therapy.

CONCLUSIONS: Our meta-analysis demonstrates that endoscopic therapy was overall associated with lower rates of rebleeding (overall and 30-day), mortality (overall and 30-day), need for surgery, and LOS, compared to conservative therapy for the management of bleeding ulcers with adherent clots. However, subgroup analysis of RCTs showed that endoscopic therapy was associated with numerically lower but statistically non-significant rates of overall rebleeding and a statistically lower rate of need for surgery compared to conservative therapy with similar overall mortality rates. Combined treatment with thermal therapy and injection therapy was the most effective treatment modality in reducing rebleeding risk. Further large-scale RCTs are needed to validate our findings.

PMID:37634184 | DOI:10.1007/s10620-023-08078-x