Tag: nevin manimala

Zhonghua Xin Xue Guan Bing Za Zhi. 2023 Mar 24;51(3):303-309. doi: 10.3760/cma.j.cn112148-20220426-00305.

ABSTRACT

Objective: To investigate the influence of blood pressure control after discharge on prognosis of patients with acute aortic syndrome (AAS) complicated with hypertension who underwent thoracic endovascular aortic repair (TEVAR). Methods: This is a retrospective case analysis. Patients diagnosed with AAS complicated with hypertension and undergoing TEVAR in Northern Theater Command General Hospital from June 2002 to December 2021 were consecutively enrolled. Average systolic blood pressure (SBP) and the occurrence of endpoint events were recorded at one month, one year and every 2 years after TEVAR. According to the patients’ average SBP, patients with average SBP<140 mmHg (1 mmHg=0.133 kPa) or<150 mmHg were divided into the target blood pressure achievement group, and the others were divided into target blood pressure non-achievement group. Endpoint events included all-cause death, aortic death, stroke, renal insufficiency, aortic related adverse events and a composite of these events (overall clinical adverse events), and re-accepting TEVAR. The incidence of endpoint events was compared between the two groups at each follow-up period. Results: A total of 987 patients were included, aged (55.7±11.7) years, including 779 male (78.9%). When the cutoff value was 140 mmHg, the rate of average target SBP achievement was 71.2% (703/987) at one month, 66.7% (618/927) during 1st to 12th month and 65.1% (542/832) from the first year to the third year after TEVAR. The proportion of patients taking≥2 antihypertensive agents was higher in the group of target blood pressure non-achievement group than the target blood pressure achievement group after TEVAR at 1 month (74.3% (211/284) vs.65.9% (463/703), P=0.010) and during 1st to 12th month (71.5% (221/309) vs. 63.6% (393/618), P=0.016). There were no statistical differences in the all-cause deaths, stroke, aortic related adverse events, and repeat TEVAR between the two groups (All P>0.05) during above follow-up periods. When the cutoff value was 150 mmHg, the rate of target SBP achievement was 89.3% (881/987) at one month, 85.2% (790/927) during 1st to 12th month and 85.6%(712/832) from the first year to the third year after TEVAR. The incidence of clinical total adverse events (8.8% (12/137) vs. 4.2% (33/790), P=0.021) and repeat TEVAR (4.4% (6/137) vs. 1.0% (8/790), P=0.003) in target blood pressure non-achievement group were significantly higher than the target blood pressure achievement group during 1st to 12th month after TEVAR. The incidence of all-cause deaths (5.8% (7/120) vs. 2.4% (17/712), P=0.037) in the target blood pressure non-achievement group was significantly higher than the target blood pressure achievement group from the first year to the third year follow-up period, but there were no statistical differences in the incidence of clinical total adverse events between the two group (P>0.05). Conclusion: Among TEVAR treated AAS patients complicated with hypertension, the average SBP more than 150 mmHg post discharge is associated with increased risk of adverse events. Ideal blood pressure control should be encouraged to improve the outcome of these patients.

PMID:36925141 | DOI:10.3760/cma.j.cn112148-20220426-00305

Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Mar 25;26(3):253-259. doi: 10.3760/cma.j.cn441530-20230222-00049.

ABSTRACT

Objective: To explore the feasibility, safety, and short- and long-term efficacy of laparoscopic pelvic exenteration (LPE) in treating locally advanced rectal cancer. Methods: The clinical data of 173 patients who had undergone pelvic exenteration (PE) for locally advanced rectal cancer that had been shown by preoperative imaging or intraoperative exploration to have invaded beyond the mesorectal excision plane and adjacent organs in the Cancer Hospital, Chinese Academy of Medical Sciences (n=64) and Peking University First Hospital (n=109) from 2010 January to 2021 December were collected retrospectively. Laparoscopic PE (LPE) had been performed on 82 of these patients and open PE (OPE) on 91. Short- and long-term outcomes (1-, 3-, and 5-year overall and disease-free survival and 1- and 3-year cumulative local recurrence rates) were compared between these groups. Results: The only statistically significant difference in baseline data between the two groups (P>0.05) was administration of neoadjuvant therapy. Compared with OPE, LPE had a significantly shorter operative time (319.3±129.3 minutes versus 417.3±155.0 minutes, t=4.531, P<0.001) and less intraoperative blood loss (175 [20-2000] ml vs. 500 [20-4500] ml, U=2206.500, P<0.001). The R0 resection rates were 98.8% and 94.5%, respectively (χ²=2.355, P=0.214). At 18.3% (15/82), and the incidence of perioperative complications was lower in the LPE group than in the OPE group (37.4% [34/91], χ²=7.727, P=0.005). The rates of surgical site infection were 7.3% (6/82) and 23.1% (21/91) in the LPE and OPE group, respectively (χ²=8.134, P=0.004). The rates of abdominal wound infection were 0 and 12.1% (11/91) (χ²=10.585, P=0.001), respectively, and of urinary tract infection 0 and 6.6% (6/91) (χ²=5.601, P=0.030), respectively. Postoperative hospital stay was shorter in the LPE than OPE group (12 [4-60] days vs. 15 [7-87] days, U=2498.000, P<0.001). The median follow-up time was 40 (2-88) months in the LPE group and 59 (1-130) months in the OPE group. The 1-, 3-, and 5-year overall survival rates were 91.3%, 76.0%, and 62.5%, respectively, in the LPE group, and 91.2%, 68.9%, and 57.6%, respectively, in the OPE group. The 1, 3, and 5-year disease-free survival rates were 82.8%, 64.9%, and 59.7%, respectively, in the LPE group and 76.9%, 57.8%, and 52.7%, respectively, in the OPE group. The 1- and 3-year cumulative local recurrence rates were 5.1% and 14.1%, respectively, in the LPE group and 8.0% and 15.1%, respectively, in the OPE group (both P>0.05). Conclusions: In locally advanced rectal cancer patients, LPE is associated with shorter operative time, less intraoperative blood loss, fewer perioperative complications, and shorter hospital stay compared with OPE. It is safe and feasible without compromising oncological effect.

PMID:36925125 | DOI:10.3760/cma.j.cn441530-20230222-00049

Zhonghua Yi Xue Za Zhi. 2023 Mar 21;103(11):842-849. doi: 10.3760/cma.j.cn112137-20221101-02280.

ABSTRACT

Objective: To explore the predictive performance of image quantitative index model, clinical-laboratory index model and image-clinical multi-dimensional fusion model in predicting the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) with intraventricular hemorrhage (IVH). Methods: A total of 349 patients with aSAH and IVH, including 122 males and 227 females, aged 22 to 85 (59±11) years underwent CT scan in the General Hospital of Eastern Theater Command from January 2010 to December 2019 were used as dataset 1 to construct a prognostic model. A prognostic model was constructed for data set 1, and the functional recovery of patients 12 months after discharge was evaluated using the modified Rankin Scale (mRS). According to the results, those patients were divided into two groups: good outcome group (n=267) and poor outcome group (n=82). In addition, 63 aSAH patients with IVH, including 27 males and 36 females, aged 32 to 87 (61±12) years who were admitted to the General Hospital of Eastern Theater Command from January 2020 to December 2021 were collected as dataset 2 for independent verification of the model, including 30 patients with poor prognosis. Clinical information (age and gender), laboratory indicators (blood routine and blood biochemistry), and imaging quantitative indicators (such as volume, density, shape of each ventricle hemorrhage area outlined and extracted on head CT scan etc.) were recorded for all patients (dataset 1 and 2). The clinical, laboratory and imaging quantitative indicators of dataset 1 were screened by using L1 regularization and multiple logistic regression method was used to construct the clinical-laboratory index model, image quantitative index model and image-clinical multi-dimensional fusion model, according to the weight coefficient of features in the clinical-laboratory index model and image quantitative index model, screen out the main features. The model was trained and internally validated by 5-fold cross-validation. The model was validated independently in dataset 2. Results: The AUC (area under the ROC curve) of clinical-laboratory index model, image quantitative index model and multidimensional fusion model constructed based on dataset 1 were 0.75 (95%CI: 0.69-0.81), 0.68 (95%CI: 0.61-0.74) and 0.86 (95%CI: 0.82-0.91). The Delong test showed that there were statistically significant differences between the performance of the multi-dimensional fusion model and the clinical-laboratory index model or image quantitative index model (all P<0.05). The AUC of clinical-laboratory index model, image quantitative index model and multidimensional fusion model of dataset 2 were 0.79 (95%CI: 0.68-0.91), 0.70 (95%CI: 0.57-0.83) and 0.81 (95%CI: 0.70-0.92). In addition, in the clinical-laboratory index model and imaging quantitative index model constructed based on data 1, age, Hunt-Hess grade on admission, Neutrophil/Lymphocyte (N/L) (the weight coefficients in the clinical-laboratory index model were 1.00, -0.59 and 0.44) and the standard deviation of third ventricle hemorrhage density, minimum hemorrhage density of the fourth ventricle, and left ventricle hemorrhage sphericity (the weight coefficients in the image quantitative index model were -1.00, 0.85 and -0.84) were the main features of the screening. Conclusions: Quantitative imaging indicators of ventricular hemorrhage (standard deviation of third ventricular hemorrhage density, minimum density of fourth ventricular hemorrhage, and left ventricular sphericity) are helpful to predict the poor prognosis of patients with aSAH with ventricular hemorrhage. Dimensional fusion model has greater value in predicting poor prognosis of patients.

PMID:36925118 | DOI:10.3760/cma.j.cn112137-20221101-02280

Vestn Oftalmol. 2023;139(1):99-105. doi: 10.17116/oftalma202313901199.

ABSTRACT

PURPOSE: This study examines the efficacy and safety of brolucizumab in the treatment of diabetic macular edema (DME) in real clinical practice in the Russian Federation.

MATERIAL AND METHODS: The study included 14 consecutive treatment-naïve DME patients, among them 7 males and 7 females (21 eyes in total) with mean age of 65.1±8.0 years. Patients underwent standard ophthalmological examination and multimodal imaging, including optical coherence tomography. All patients received intravitreal injections of brolucizumab every 6 weeks. A total of 73 injections were performed. A data analysis was performed for 10 eyes of 10 patients 6 months after initiation of the treatment.

RESULTS: After 4 injections of brolucizumab, best-corrected visual acuity (BCVA) increased statistically significantly from 35.8±13.7 to 41.5±11.9 ETDRS letters (p=0.03), central retinal thickness (CRT) and macular volume (MV) decreased from 411.5±107.4 to 280.2±64.6 microns (p=0.014) and from 7.39±0.92 to 6.16±7.37 mm³ (p=0.0006), respectively. The average gain of visual acuity was 5.7±7.0 letters, average decrease of CRT was -131.3±91.2, and average decrease of MV was -1.21±0.75 mm³. There were no adverse events associated with intraocular inflammation.

CONCLUSION: Intravitreal injections of brolucizumab provide significant anatomical and functional improvement to DME patients in real clinical practice with results comparable to that of randomized clinical trials.

PMID:36924521 | DOI:10.17116/oftalma202313901199

Vestn Oftalmol. 2023;139(1):46-54. doi: 10.17116/oftalma202313901146.

ABSTRACT

PURPOSE: The study evaluates the effectiveness of eyelid hygiene (EH) in correction of the ocular surface (OS) condition in patients with dry eye disease (DED) ahead of cataract phacoemulsification (CPE).

MATERIAL AND METHODS: The study included 90 patients with cataract: the first group consisted of 45 DED patients with lipid deficiency, the second group – 45 DED patients with lipid/mucous deficiency. Prior to CPE, all patients were randomized into three subgroups of 15 people each. In subgroups 1.1 and 2.1 patients did not receive any treatment for correction of the state of ocular surface. Patients in subgroups 1.2 and 1.3 were instilled 0.18% sodium hyaluronate (SH); in subgroups 2.2 and 2.3 – fixed combination of 0.15% SH and 3% trehalose. In subgroups 1.3 and 2.3 EH was performed (with «Blefarogel cleansing», «Blefarolotion», «Blefarogel-1» two times a day for one month before CPE). The control points were: 1) at study inclusion; 2) after correction of the ocular surface condition; 3) 30 days after CPE. The following parameters were evaluated: OSDI, TBUT (Norn’s test), severity of meibomian gland dysfunction (MGD), patient satisfaction with CPE (CPE-PS). Statistical analysis: M±SD calculation, Mann–Whitney, Kruskal-Wallis and Wilcoxon tests.

RESULTS: At the second control point, a statistically significant more pronounced OSDI decrease and bigger increase in TBUT were observed in subgroups 1.3 and 2.3 compared to subgroups 1.2 and 2.2 (Mann-Whitney U-test). Apparently, this was associated with a reduction in MGD severity in patients who received EH. At the third control point, significant lower values of OSDI and MGD severity, higher TBUT values and greater CFE-PS were recorded in subgroups 1.3 and 2.3 (Kruskal-Wallis test, Wilcoxon two-sample test).

CONCLUSION: Carrying out EH using the «Blefarogel cleansing», «Blefarolotion», «Blefarogel-1» and artificial tear in patients with DED and cataract can increase the efficiency of correction of ocular surface condition and improve patient satisfaction with the outcome of CPE.

PMID:36924514 | DOI:10.17116/oftalma202313901146

Vestn Oftalmol. 2023;139(1):35-45. doi: 10.17116/oftalma202313901135.

ABSTRACT

PURPOSE: This study provides a detailed analysis of the bioinorganic chemical composition of lens substance in patients with senile cataract using classical and spatial statistics methods.

MATERIAL AND METHODS: The study included 30 isolated human lenses. The light scattering ability (LSA) of the lens substance was evaluated using an original method. Additionally, distribution of chemical elements in the lens substance was analyzed using a scanning electron microscope with energy dispersive spectrometer (SEM/EDS). Measurements by all methods were carried out in a single coordinate space, which made it possible to compare the spatial correlation of different parameters.

RESULTS: Small-angle light scattering of the lens substance has been quantitatively characterized for the first time. In contrast to the conventional norm, in senile cataract the accumulation fields of the majority of ion-forming elements (including Na, P, K, Cl) are distributed along the lines repeating the geometry of the lens capsule. At the same time, the light scattering ability of certain areas of the lens is significantly correlated with changes in the concentrations of Na, P, K, Ca in these areas. In particular, one ion-forming element can be distinguished – Na: spatial change of its concentration in senile cataract is strongly associated with a local change in LSA of the lens with opacities clustering of any degree. Thus, a change in the nature of the Na accumulation in the lens volume can be considered the main marker of senile cataract formation.

CONCLUSION: The distribution pattern of ion-forming elements indicates that the loss of barrier properties in the capsule plays a significant role in the development of senile cataract.

PMID:36924513 | DOI:10.17116/oftalma202313901135

Neurosurgery. 2023 Apr 1;69(Supplement_1):22. doi: 10.1227/neu.0000000000002375_101.

ABSTRACT

INTRODUCTION: Symptomatic intracranial atherosclerotic disease (sICAD) is estimated to cause over 10% of strokes annually in the US alone. Previous investigations employing stenting, most notably SAMMPRIS trial, have produced unfavorable results in regards to both periprocedural complications and risk of recurrent stroke. However, newer generation balloon-mounted drug-eluting stents (BM-DES) have been hypothesized to harbor several technical advantages that may confer improvements in these critical metrics.

METHODS: Prospectively maintained databases from eight comprehensive stroke centers were reviewed to identify adult patients undergoing RO-ZES for the treatment of sICAD between January,2019 and December,2021. Only patients that presented with either recurrent stroke or TIA, intracranial stenosis 70-99%, with at least one stroke on best medical management were included. The primary outcome was 30-days composite of stroke, ICH, and/or mortality. A propensity-score matched analyses was performed comparing the results of RO-ZES to the intervention arm of SAMMPRIS.

RESULTS: A total of 132 patients met the inclusion criteria for analysis (mean age:64.2 years). Mean severity of stenosis (±SD) was 81.4% (±11.4%). Four (3.03%) stroke and/or deaths were reported within 30 days in RO-ZES group. A propensity-score matched analysis based on age, HLD, HTN, DMII, and smoking demonstrated a statistically significant decreased risk of 30-day stroke and/or death rate in RO-ZES in comparison to SAMMPRIS (2.6% vs. 15.6%, respectively; OR 6.88, 95% CI 1.92-37.54, p < 0.001).

CONCLUSIONS: Patients treated with RO-ZES had a decreased rate of 30-day major complications in comparison to SAMMPRIS. Further large-scale prospective studies are warranted to evaluate the safety and efficacy of RO-ZES for the treatment of sICAD.

PMID:36924488 | DOI:10.1227/neu.0000000000002375_101

Alcohol Clin Exp Res. 2023 Mar 16. doi: 10.1111/acer.15054. Online ahead of print.

ABSTRACT

BACKGROUND: Endorsement of specific DSM-IV alcohol use disorder (AUD) criteria items changed significantly over time in men in their thirties with persistent or recurrent AUD. Few studies have documented whether endorsement of AUD items change over time in younger individuals or in women. The prospective analyses presented here evaluate changes in endorsement of AUD criteria in 377 men and women with persistent or recurrent AUD during their twenties.

METHODS: AUD item endorsement over time between average ages of 20 and 25 in 223 men and 154 women with persistent or recurrent AUD in at least three interviews were available from participants in the Collaborative Study on the Genetics of Alcoholism. Statistical significance of endorsement changes over time were evaluated using related-samples Cochran’s Q for the full sample and for men and women separately. Additional analyses evaluated potential sex differences in the patterns of change.

RESULTS: In the full sample, the predominant pattern was for significant increased rates of endorsements for six of the seven alcohol dependence criteria, but not in the four abuse items. A similar pattern was seen within men, but women demonstrated significant changes in only three of the seven dependence criteria.

CONCLUSIONS: Endorsement of the seven alcohol dependence criteria during the twenties generally increased in individuals with persistent or recurrent AUD, but few changes were observed regarding rates of endorsement of the four abuse items. The paper discusses how the results might reflect on the nature of AUD and on the DSM criteria.

PMID:36924463 | DOI:10.1111/acer.15054

Gerodontology. 2023 Mar 16. doi: 10.1111/ger.12685. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to assess dentists’ attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care.

BACKGROUND: Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists’ attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons.

METHODS: A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses.

RESULTS: There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual’s severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care.

CONCLUSIONS: The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists’ willingness to provide care; however, additional specific targeted interventions are also needed.

PMID:36924433 | DOI:10.1111/ger.12685

J Appl Clin Med Phys. 2023 Mar;24(3):e13853. doi: 10.1002/acm2.13853. Epub 2022 Nov 21.

ABSTRACT

PURPOSE: The single isocenter for multiple-target (SIMT) technique has become a popular treatment technique for multiple brain metastases. We have implemented a method to obtain a nonuniform margin for SIMT technique. In this study, we further propose a method to determine the isocenter position so that the total expanded margin volume is minimal.

MATERIALS AND METHOD: Based on a statistical model, the relationship between nonuniform margin and the distance d (from isocenter to target point), setup uncertainties, and significance level was established. Due to the existence of rotational error, there is a nonlinear relationship between the margin volume and the isocenter position. Using numerical simulation, we study the relationship between optimal isocenter position and translational error, rotational error, and target size. In order to find the optimal isocenter position quickly, adaptive simulated annealing (ASA) algorithm was used. This method was implemented in the Pinnacle³ treatment planning system and compared with isocenter at center-of-geometric (COG), center-of-volume (COV), and center-of-surface (COS). Ten patients with multiple brain metastasis targets treated with the SIMT technique was selected for evaluation.

RESULTS: When the size of tumors is equal, the optimal isocenter obtained by ASA and numerical simulation coincides with COG, COV, and COS. When the size of tumors is different, the optimal isocenter is close to the large tumor. The position of COS point is closer to the optimal point than the COV point for nearly all cases. Moreover, in some cases the COS point can be approximately selected as the optimal point. The ASA algorithm can reduce the calculating time from several hours to tens of seconds for three or more tumors. Using multiple brain metastases targets, a series of volume difference and calculating time were obtained for various tumor number, tumor size, and separation distances. Compared with the margin volume with isocenter at COG, the margin volume for optimal point can be reduced by up to 27.7%.

CONCLUSION: Optimal treatment isocenter selection of multiple targets with large differences could reduce the total margin volume. ASA algorithm can significantly improve the speed of finding the optimal isocenter. This method can be used for clinical isocenter selection and is useful for the protection of normal tissue nearby.

PMID:36924428 | DOI:10.1002/acm2.13853