Tag: nevin manimala

Am Surg. 2023 May 31:31348231180915. doi: 10.1177/00031348231180915. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with peritoneal carcinomatosis (PC) can develop malignant bowel obstructions (MBOs) requiring inpatient admission and nasogastric tube decompression. Palliative decompressive gastrostomy tubes (G-tubes) may affect patient disposition, allowing for self-management and reduction in inpatient services. Therefore, we sought to assess disposition and inpatient readmission rates in patients admitted with PC and MBO following G-tube placement.

METHODS: The Vizient® Clinical Data Base was queried for inpatient admissions from October 2018 to May 2022 utilizing ICD-10 codes to identify patients admitted with PC and bowel obstruction, with or without G-tube placement. Demographics and hospital outcomes were recorded. Descriptive statistics and multivariate logistic regression analysis were performed.

RESULTS: From 750 patients, 59 (7.9%) had a G-tube placed. Compared to patients without G-tubes, those with G-tubes had lower rates of disposition to home (32.2% vs 70.0%, P < .001) and higher rates of disposition to hospice (home: 30.5% vs 7.8%, P < .001, facility: 10.2% vs 3.9%, P = .02). There was no significant difference in the rate (17.3% vs 22.3%, P = .40) or risk (OR = 1.44, 95% CI .69-3.01) of 30-day readmissions with G-tubes. However, palliative care consultation (OR 33.77, 95% CI 19.16-59.52) and G-tube placement (OR 5.82, 95% CI 2.56-13.25) were independent predictors for hospice.

DISCUSSION: Placement of G-tubes in patients with PC and MBO was associated with higher rates of disposition to hospice but there is no difference in 30-day readmission rates compared to those without G-tubes. Further prospective studies are needed to understand the role of G-tube placement in patients with MBO in relation to outcomes and disposition.

PMID:37257144 | DOI:10.1177/00031348231180915

J Clin Oncol. 2023 May 31:JCO2202200. doi: 10.1200/JCO.22.02200. Online ahead of print.

ABSTRACT

PURPOSE: Blinatumomab, a bispecific T-cell engager immunotherapy, is efficacious in relapsed/refractory B-cell ALL (B-ALL) and has a favorable toxicity profile. One aim of the Children’s Oncology Group AALL1331 study was to compare survival of patients with low-risk (LR) first relapse of B-ALL treated with chemotherapy alone or chemotherapy plus blinatumomab.

PATIENTS AND METHODS: After block 1 reinduction, patients age 1-30 years with LR first relapse of B-ALL were randomly assigned to block 2/block 3/two continuation chemotherapy cycles/maintenance (arm C) or block 2/two cycles of continuation chemotherapy intercalated with three blinatumomab blocks/maintenance (arm D). Patients with CNS leukemia received 18 Gy cranial radiation during maintenance and intensified intrathecal chemotherapy. The primary and secondary end points were disease-free survival (DFS) and overall survival (OS).

RESULTS: The 4-year DFS/OS for the 255 LR patients accrued between December 2014 and September 2019 were 61.2% ± 5.0%/90.4% ± 3.0% for blinatumomab versus 49.5% ± 5.2%/79.6% ± 4.3% for chemotherapy (P = .089/P = .11). For bone marrow (BM) ± extramedullary (EM) (BM ± EM; n = 174) relapses, 4-year DFS/OS were 72.7% ± 5.8%/97.1% ± 2.1% for blinatumomab versus 53.7% ± 6.7%/84.8% ± 4.8% for chemotherapy (P = .015/P = .020). For isolated EM (IEM; n = 81) relapses, 4-year DFS/OS were 36.6% ± 8.2%/76.5% ± 7.5% for blinatumomab versus 38.8% ± 8.0%/68.8% ± 8.6% for chemotherapy (P = .62/P = .53). Blinatumomab was well tolerated and patients had low adverse event rates.

CONCLUSION: For children, adolescents, and young adults with B-ALL in LR first relapse, there was no statistically significant difference in DFS or OS between the blinatumomab and standard chemotherapy arms overall. However, blinatumomab significantly improved DFS and OS for the two thirds of patients with BM ± EM relapse, establishing a new standard of care for this population. By contrast, similar outcomes and poor DFS for both arms were observed in the one third of patients with IEM; new treatment approaches are needed for these patients (ClinicalTrials.gov identifier: NCT02101853).

PMID:37257143 | DOI:10.1200/JCO.22.02200

Plast Reconstr Surg. 2023 May 31. doi: 10.1097/PRS.0000000000010784. Online ahead of print.

ABSTRACT

BACKGROUND: Computer-assisted surgical simulation (CASS) allows more precise orthognathic surgery. However, few studies have evaluated associations between CASS-designed bilateral sagittal split osteotomy (BSSO) and bone contact surface in class II mandibular asymmetry. This study aims to evaluate the effects of using computer-assisted simulation and design modification of sagittal split osteotomy (SSO) to improve bony contact in skeletal class II asymmetry.

METHODS: This retrospective analysis reviewed 28 patients with class II asymmetry who underwent orthognathic surgery, including 15 with modified SSO (group CS) and 13 with conventional SSO (group C). Modified SSO was designed under CASS. Operative characteristics, postoperative outcomes, and complications were collected and compared between the two groups.

RESULTS: Bony contact was found at the distal end of the proximal segment in all group CS patients, while bone gap was noted in all group C patients (p<0.05). Moreover, bone graft was used in four group C patients but was not used in all cases group CS patients (p<0.05). A trend toward lower operative time or perioperative bleeding was noted in group CS, but without statistical significance. After 1-year follow-up, inferior alveolar nerve disturbances were noted in two group CS patients and one group C patient. Palpable bone gap with uneven jaw line was noted in two group C patients one year after surgery and one patient received fat graft treatment.

CONCLUSION: The simulation-based sagittal split osteotomy modification provides appropriate contact surface and eliminates the bone gap between proximal and distal segments in class II asymmetry.

PMID:37257138 | DOI:10.1097/PRS.0000000000010784

Plast Reconstr Surg. 2023 May 31. doi: 10.1097/PRS.0000000000010773. Online ahead of print.

ABSTRACT

BACKGROUND: It remains unclear if physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index (BMI) on CTS severity is not well characterized.

METHODS: Unilateral and bilateral CTS patients were seen from October 2014-February 2021. Obese and non-obese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6 measures were obtained. NCS recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used the Wilcoxon signed-rank testing for paired continuous variables, Mann-Whitney U testing for non-paired continuous variables, and chi-squared for continuous variables with a significance level of p < 0.05.

RESULTS: 109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score (p < 0.0001), CTS-6 score (p < 0.0001), DML (p < 0.0001), and DSL (p < 0.01). Bilateral patients also had higher symptom severity scale (p < 0.01) and DSL (p < 0.001) outcomes compared to unilateral. Obese patients had higher median nerve CSA (p < 0.01), prolonged DML, and DSL (p < 0.0001) values despite similar CTS severity (BCTSQ, CTS-6).

CONCLUSIONS: Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS, BCTSQ). Obesity increases median nerve CSA and prolongs NCS without influencing CTS severity. This information can be utilized when considering which diagnostic testing to order for CTS.

LEVEL OF EVIDENCE: Level 3 Diagnostic.

PMID:37257136 | DOI:10.1097/PRS.0000000000010773

Plast Reconstr Surg. 2023 May 31. doi: 10.1097/PRS.0000000000010785. Online ahead of print.

ABSTRACT

BACKGROUND: Children born with hemifacial microsomia (HFM) can suffer from airway compromise. There is a paucity of data correlating degree of HFM severity with airway difficulty. This study aims to determine the relationship between degree of micrognathia and airway insufficiency in the HFM population.

METHODS: Patient demographics, airway function, Kaban-Pruzansky (KP) grade, and Cormack Lehane (CL) grade were collected and compared with appropriate statistics for HFM patients treated between 2000 and 2022.

RESULTS: Seventy patients underwent 365 operations with KP grading as follows: 34% I, 23% IIA, 11% IIB, and 33% grade III. Goldenhar syndrome was present in 40% of patients and 16% had bilateral disease. KP grade (p<0.001) predicted mean number of airway-affecting procedures undergone and difficult airway status (p<0.001), with 75% of difficult airways in KP III patients. There was no association of airway compromise with Goldenhar syndrome, laterality, or age (p>0.05). Most CL grades were I (61%) or IIA (13%), with fewer IIB, III, and IV (4-7%). KP grade predicted CL grade (p<0.001), with 71% of grade IV views and 64% of grade III views seen in KP III patients.

CONCLUSIONS: Kaban-Pruzansky grade correlated with airway severity in HFM. Patients do not appear to outgrow their CL grade, as previously hypothesized, suggesting that KP III patients remain at increased risk for airway insufficiency into the teen years. Given the potential significant morbidity associated with airway compromise, proper identification and preparation for challenging airway is a critical part of caring for patients with HFM.

PMID:37257130 | DOI:10.1097/PRS.0000000000010785

Chin Med J (Engl). 2023 May 31. doi: 10.1097/CM9.0000000000002674. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer is one of the most common cancer in women and a proportion of patients experiences brain metastases with poor prognosis. The study aimed to construct a novel predictive clinical model to evaluate the overall survival (OS) of patients with postoperative brain metastasis of breast cancer (BCBM) and validate its effectiveness.

METHODS: From 2010 to 2020, a total of 310 female patients with BCBM were diagnosed in The Affiliated Cancer Hospital of Xinjiang Medical University, and they were randomly assigned to the training cohort and the validation cohort. Another 173 BCBM patients were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database as an external validation cohort. In the training cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression model was used to determine the fundamental clinical predictive indicators and the nomogram was constructed to predict OS. The model capability was assessed using receiver operating characteristic, C-index, and calibration curves. Kaplan-Meier survival analysis was performed to evaluate clinical effectiveness of the risk stratification system in the model. The accuracy and prediction capability of the model were verified using the validation and SEER cohorts.

RESULTS: LASSO Cox regression analysis revealed that lymph node metastasis, molecular subtype, tumor size, chemotherapy, radiotherapy, and lung metastasis were statistically correlated with BCBM. The C-indexes of the survival nomogram in the training, validation, and SEER cohorts were 0.714, 0.710, and 0.670, respectively, which showed good prediction capability. The calibration curves demonstrated that the nomogram had great forecast precision, and a dynamic diagram was drawn to increase the maneuverability of the results. The Risk Stratification System showed that the OS of low-risk patients was considerably better than that of high-risk patients (P <0.001).

CONCLUSION: The nomogram prediction model constructed in this study has a good predictive value, which can effectively evaluate the survival rate of patients with postoperative BCBM.

PMID:37257115 | DOI:10.1097/CM9.0000000000002674

Water Sci Technol. 2023 May;87(10):2457-2473. doi: 10.2166/wst.2023.076.

ABSTRACT

A novel treatment method, consisting of pea-gravel with a marine coating supplemented with alkyldimethylbenzylammonium chloride (ADBAC or benzalkonium chloride), has been examined for its antimicrobial performance and coating stability in aqueous environments. Initial column studies examining the porous media’s ability to reduce bacterial loads in heating, ventilation, and air conditioning (HVAC) water found average reductions of 94% from pre-flush levels (10⁶ colony forming unit (CFU)/mL) when assessed with R2A spread plates and 83% reductions with SimPlates. There was no observed statistical difference between the average of pre- and post-flush waters from four tests of the media without ADBAC. Taxonomic identification, by 16S rRNA gene sequencing, of colonies drawn from pre- and post-ABDAC R2A plates showed similarities with taxa observed in high frequency from prior cultivation-independent surveys of other cooling tower systems. With this proof of concept, two versions of the media were evaluated for potential coating components released during aqueous exposure. Neither released measurable volatile organic compounds (VOC) components, but one did release bisphenol A and ABDAC compounds. Subsequent column tests of the more durable coating were conducted using cultures of interest in industrial water and demonstrated significant reductions in neutralized post-column Enterococcus faecalis samples and near complete loss of Legionella pneumophila in non-neutralized fluids, but lower reductions in Pseudomonas aeruginosa.

PMID:37257103 | DOI:10.2166/wst.2023.076

Plast Reconstr Surg. 2023 May 31. doi: 10.1097/PRS.0000000000010775. Online ahead of print.

ABSTRACT

BACKGROUND: Dupuytren’s disease (DD) is a common complex trait, with varying severity and incompletely understood etiology. Genome-wide association studies (GWAS) have identified risk loci. Here, we examine whether genetic risk profiles of DD in patients are associated with clinical variation and disease severity as well as with patient genetic risk profiles of genetically correlated traits, including body mass index (BMI), triglycerides (TG), high-density lipoproteins (HDL), type 2 diabetes mellitus (T2D), and endophenotypes fasting glucose (FG), and glycated hemoglobin (HbA1c).

METHODS: We used a well-characterized cohort of 1,461 DD patients with available phenotypic and genetic data. Phenotype data include age of onset, recurrence, and family history of disease. Polygenic risk scores (PRSs) of DD, BMI, TG, HDL, T2D, FG, and HbA1c using various significance thresholds were calculated with PRSice using the most recent GWAS summary statistics. Control data from LifeLines were used to determine p-value cut-offs for PRSs generation explaining most variance.

RESULTS: The PRS for DD was significantly associated with a positive family history for DD, age of onset, disease onset before the age of 50, and recurrence. We also found a significant negative correlation between the PRSs for DD and BMI.

CONCLUSIONS: While GWAS studies of DD are designed to identify genetic risk factors distinguishing case/control status, we show that the genetic risk profile for DD also explains part of its clinical variation and disease severity. The PRS may therefore aid in accurate prognostication, choosing initial treatment and in personalized medicine in future.

PMID:37257093 | DOI:10.1097/PRS.0000000000010775

J Chem Theory Comput. 2023 May 31. doi: 10.1021/acs.jctc.3c00308. Online ahead of print.

ABSTRACT

In molecular dynamics simulations in the NPT ensemble at constant pressure, the size and shape of the periodic simulation box fluctuate with time. For particle images far from the origin, the rescaling of the box by the barostat results in unbounded position displacements. Special care is thus required when a particle trajectory is unwrapped from a projection into the central box under periodic boundary conditions to a trajectory in full three-dimensional space, e.g., for the calculation of translational diffusion coefficients. Here, we review and compare different schemes in use for trajectory unwrapping. We also specify the corresponding rewrapping schemes to put an unwrapped trajectory back into the central box. On this basis, we then identify a scheme for the calculation of diffusion coefficients from NPT simulations, which is a primary application of trajectory unwrapping. In this scheme, the wrapped and unwrapped trajectory are mutually consistent and their statistical properties are preserved. We conclude with advice on best practice for the consistent unwrapping of constant-pressure simulation trajectories and the calculation of accurate translational diffusion coefficients.

PMID:37257090 | DOI:10.1021/acs.jctc.3c00308

Diabetes Care. 2023 May 31:dc222372. doi: 10.2337/dc22-2372. Online ahead of print.

ABSTRACT

OBJECTIVE: Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years.

RESEARCH DESIGN AND METHODS: This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures. Causal inference is based on dynamic changes in individual CMPs between years by practice. We used the Bayesian method to simultaneously estimate a five-outcome model: A1c, systolic and diastolic blood pressure, guideline-based statin use, and Optimal Diabetes Care (ODC). We control for unobserved time-invariant practice characteristics and secular change. We modeled correlation of errors across outcomes. Statistical significance was identified using 99% Bayesian credible intervals (analogous to P < 0.01).

RESULTS: Implementation of 18 of 62 CMPs was associated with statistically significant improvements in patient outcomes. Together, these resulted in 12.1% more patients meeting ODC performance measures. Different CMPs affected different outcomes. Three CMPs accounted for 47% of the total ODC improvement, 68% of A1c decrease, 21% of SBP reduction, and 55% of statin use increase: 1) systems for identifying and reminding patients due for testing, 2) after-visit follow-up by a nonclinician, and 3) guideline-based clinician reminders for preventive services during a clinic visit.

CONCLUSIONS: Effective quality improvement in primary care focuses on practice redesign that clearly improves diabetes outcomes. Tailoring CMP adoption in primary care provides effective improvement in ODC performance through focused changes in diabetes outcomes.

PMID:37257083 | DOI:10.2337/dc22-2372