Tag: nevin manimala

Ann Surg Oncol. 2022 Nov 30. doi: 10.1245/s10434-022-12869-3. Online ahead of print.

ABSTRACT

BACKGROUND: Prior studies of older cancer patients undergoing large operations have reported similar rates of complications to the general population but higher rates of mortality, suggesting higher rates of failure-to-rescue (FTR) with advanced age. Whether age is a marker for frailty, or an independent predictor of FTR, is not clear.

METHODS: The ACS-NSQIP database was queried from 2015-19 for patients undergoing surgery for gastrointestinal (GI) malignancy. Patients were divided into age-stratified cohorts: C1 (18-55), C2 (56-65), C3 (66-75), C4 (76-89). Adjusted odds ratios (aOR) were computed to assess the relationship of the FTR rate and age, while controlling for potential confounders. A second analysis was specified with all covariates converted to Z-scores, which generated scaled adjusted odds ratios (saOR) to determine the strongest predictor of FTR.

RESULTS: Multivariable analysis suggests that age is an independent predictor of FTR: C2:C1 aOR = 1.87 (p < 0.001); C3:C1 aOR = 3.33 (p < 0.001); C4:C1 aOR = 5.71 (p < 0.001). The scaled analysis demonstrated that age is the strongest predictor of FTR (saOR = 1.92, p < 0.001); a one standard deviation increase in age was associated with a 92% increased odds of FTR. The saOR for frailty (1.18, p < 0.001) and for number of comorbidities (1.10, p = 0.005) also were statistically significant.

CONCLUSIONS: Chronologic age was independently associated with increased FTR after surgery for GI malignancy and was the strongest predictor of FTR. These results suggest that chronologic age must be carefully considered when evaluating the fitness of a patient for GI cancer surgery.

PMID:36449206 | DOI:10.1245/s10434-022-12869-3

Cancer Treat Res. 2022;184:113-127. doi: 10.1007/978-3-031-04402-1_8.

ABSTRACT

Logistic regression is a statistical tool of paramount significance in the field of epidemiology¹ and ranks as one of the most frequently published multivariable analyses for designs involving a single binary dependent variable and one or more independent variables in the fields of public health^2,3 and medical⁴ research.

PMID:36449192 | DOI:10.1007/978-3-031-04402-1_8

Drugs R D. 2022 Nov 30. doi: 10.1007/s40268-022-00408-0. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Systemic lupus erythematosus (SLE) is an autoimmune disease, with hydroxychloroquine being the main therapeutic agent for the treatment of SLE. This research explored the effects of hydroxychloroquine combined with low-dose aspirin on maternal and infant outcomes and cytokines of pregnant women with SLE.

METHODS: Ninety pregnant women with SLE were divided into the hydroxychloroquine (HCQ) group (45 cases) and the hydroxychloroquine combined with low-dose aspirin (HCQASP) group (45 cases) by random number table. Patients in the HCQ group were treated with oral administration of hydroxychloroquine, while patients in the HCQASP group were treated with low-dose aspirin based on oral administration of hydroxychloroquine. Pregnancy outcomes, fetal outcomes, and cytokine levels were statistically analyzed.

RESULTS: The HCQASP group had a significantly higher proportion of full-term pregnancies and a significantly lower proportion of hypertension, prematurity, and pregnancy loss than the HCQ group. Neonates in the HCQASP group also had significantly higher birth weights and Apgar scores and a significantly lower proportion of neonatal asphyxia than the HCQ group. After treatment, the HCQASP group had significantly higher interleukin (IL-2) and interferon (IFN)-γ levels and significantly lower IL-4 and IL-10 levels than the HCQ group.

CONCLUSION: Hydroxychloroquine combined with low-dose aspirin can effectively improve the pregnancy outcomes of pregnant women with SLE by affecting the levels of T helper (Th) 2 and Th1 cytokines.

PMID:36449182 | DOI:10.1007/s40268-022-00408-0

Pharmacoeconomics. 2022 Nov 30. doi: 10.1007/s40273-022-01218-7. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to estimate the relationship between EQ-5D-3L and EQ-5D-5L, in both directions, using a single model.

METHODS: An online survey containing both variants of EQ-5D, with randomised ordering, was administered to a large UK sample in 2020. A joint statistical model of the ten EQ-5D responses (five at 5L, five at 3L), using a multi-equation ordinal regression framework was estimated. The joint model ensures mappings in either direction are fully consistent with the information in the sample and satisfy Bayes’ rule. Three extensions enhance model flexibility: a copula specification allows differing degrees of correlation between the 3L and 5L responses at the upper and lower extremes of health; a normal mixture residual distribution gives flexibility in the distributional form of responses; and a common factor captures correlations in responses across the five dimensions.

RESULTS: Almost 50,000 responses were received. Thirty-five percent of respondents reported an existing medical condition. Ninety percent of possible 3L and 43% of possible 5L health states were observed. The preferred model specification includes age, sex and the responses to the EQ-5D instrument. Close alignment to the observed data was observed both in within-sample and out-of-sample comparisons.

CONCLUSION: The results from this study provide a means of translating evidence to or from EQ-5D-3L to or from 5L based on a large-scale UK population survey with randomised ordering. Mapping can be performed either using descriptive system responses, individual utility scores or summary statistics.

PMID:36449173 | DOI:10.1007/s40273-022-01218-7

J Racial Ethn Health Disparities. 2022 Nov 30. doi: 10.1007/s40615-022-01477-2. Online ahead of print.

ABSTRACT

PURPOSE: This study explores whether nativity differences in health care and sociodemographic factors help to account for nativity differences in low birth weight (LBW) when comparing US-born Black women (USBW) to Black Immigrant women (BIW).

METHODS: Bivariate analyses and multinomial nested logit (MNL) models were performed using the National Survey of Family Growth (NSFG) dataset.

RESULTS: Statistically significant nativity differences between USBW and BIW were found across variables of LBW (p = .009), marital status (p < .001), education level (p < .001), receiving public assistance (p < .001), health care coverage (p < .001), age (p < .001), and poverty level income (p < .001). Results from the MNL models indicated that BIW were 91% less likely to have a LBW baby (p < .001). When accounting for other sociodemographic and health care related variables differing by nativity, although a statistically significant, narrowing gap between BIW and USBW was observed (OR = .12, p < .001), BIW were still less likely to have a LBW baby.

CONCLUSIONS: Differences between USBW and BIW across sociodemographic variables and health care related factors related to adverse pregnancy outcomes were observed in this study. Controlling for the factors attenuated nativity differences but did not eliminate the differences on LBW. Future research should continue to explore this relationship.

PMID:36449128 | DOI:10.1007/s40615-022-01477-2

Environ Geochem Health. 2022 Nov 30. doi: 10.1007/s10653-022-01441-3. Online ahead of print.

ABSTRACT

The dramatic upsurge of artisanal and small-scale gold mining (ASGM) activities in Ghana has resulted in environmental degradation, water pollution and human exposure to mercury-the main hazardous element used in gold extraction. This study evaluated the degree of human exposure to mercury based on the concentrations found in the air and soil samples taken at a resolution of 1 km² across Konongo, a historic mining town in Ghana’s Ashanti Region. The highest atmospheric mercury concentration was 193 ng/m³, which is much higher than the levels the European Union and Japan allowed, which are 10 ng/m³ and 40 ng/m³, respectively. The concentration in the soil was 3.6 mg Hg/kg, which is around ten times higher than the background concentration in nature. Additionally, the soil concentrations were higher above the worrisome levels of soil contamination in agricultural land (4 mg/kg) and industrial areas (16 mg/kg), respectively. Soils are extremely contaminated with mercury at sites artisanal mining activities take place. The concentrations of mercury in the air and soils were significantly higher (p < 0.5) at locations of prominent mining activities compared to areas not close to mining sites. The inhabitants of the Konongo community are therefore exposed to mercury, most likely emitted from artisanal mining activities. A non-carcinogenic risk is posed to the people by inhaling mercury vapour through the air and vapourisation from the soil. Children are exposed to a higher risk than adults as they receive higher daily doses of mercury than adults.

PMID:36449127 | DOI:10.1007/s10653-022-01441-3

MAGMA. 2022 Nov 30. doi: 10.1007/s10334-022-01049-9. Online ahead of print.

ABSTRACT

OBJECTIVE: An early metabolic signature associated with the responsiveness to treatment can be useful in the better management of septic shock patients. This would help clinicians in designing personalized treatment protocols for patients showing non-responsiveness to treatment.

METHODS: We analyzed the serum on Day 1 (n = 60), Day 3 (n = 47), and Day 5 (n = 26) of patients with septic shock under treatment using NMR-based metabolomics. Partial least square discriminant analysis (PLS-DA) was performed to generate the list of metabolites that can be identified as potential disease biomarkers having statistical significance (that is, metabolites that had a VIP score > 1, and p value < 0.05, False discovery rate (FDR) < 0.05).

RESULTS: Common significant metabolites amongst the three time points were obtained that distinguished the patients being responsive (R) and non-responsive (NR) to treatments, namely 3 hydroxybutyrate, lactate, and phenylalanine which were lower, whereas glutamate and choline higher in patients showing responsiveness.

DISCUSSION: The study gave these metabolic signatures identifying patients’ responsiveness to treatment. The results of the study will aid in the development of targeted therapy for ICU patients.

PMID:36449125 | DOI:10.1007/s10334-022-01049-9

J Math Biol. 2022 Nov 30;86(1):6. doi: 10.1007/s00285-022-01840-1.

ABSTRACT

It is well known that Keller-Segel models serve as a paradigm to describe the self aggregation phenomenon, which exists in a variety of biological processes such as wound healing, tumor growth, etc. In this paper, we study the existence of monotone decreasing spiky steady state and its linear stability property in the Keller-Segel model with logistic growth over one-dimensional bounded domain subject to homogeneous Neumann boundary conditions. Under the assumption that chemo-attractive coefficient is asymptotically large, we construct the single boundary spike and next show this non-constant steady state is locally linear stable via Lyapunov-Schmidt reduction method. As a consequence, the multi-symmetric spikes are obtained by reflection and periodic extension. In particular, we present the formal analysis to illustrate our rigorous theoretical results.

PMID:36449113 | DOI:10.1007/s00285-022-01840-1

Pediatr Nephrol. 2022 Nov 30. doi: 10.1007/s00467-022-05803-y. Online ahead of print.

ABSTRACT

BACKGROUND: Primary hyperoxaluria type 1 (PH1) is an autosomal recessive disease caused by the liver defect of oxalate metabolism, which leads to kidney failure and systemic manifestations. Until recently, liver transplantation was the only definitive treatment. The timing of liver transplantation can be early, while kidney function is still normal (pre-emptive liver transplantation-PLT), or when the patient reaches stage 5 chronic kidney disease (CKD) and needs combined liver-kidney transplantation. We aimed to determine the long-term kidney outcomes of PLT in PH1 patients.

METHODS: A retrospective single-center study of PH1 patients who were followed in our center between 1997 and 2017. We compared the kidney outcomes of patients who underwent PLT to those who presented with preserved kidney function and did not undergo PLT.

RESULTS: Out of 36 PH1 patients, 18 patients were eligible for PLT (eGFR > 40 mL/min/1.73 m² at the time of diagnosis). Seven patients underwent PLT (PLT group), while 11 continued conservative treatments (PLTn group). In the PLT group, the median eGFR at the time of PLT and at the end of the follow-up period (14-20 years) was 72 (range 50-89) and 104 (range 86-108) mL/min/1.73 m², respectively, and no patient died or reached stage 5 CKD. In the PLTn group, eight patients (72.7%) reached stage 5 CKD (median time to kidney replacement therapy was 11 years), and two patients died from disease complications (18.2%).

CONCLUSIONS: Pre-emptive liver transplantation preserved kidney function in patients with PH1 in our cohort. Early intervention can prevent kidney failure and systemic oxalosis in PH1. A higher resolution version of the Graphical abstract is available as Supplementary information.

PMID:36449101 | DOI:10.1007/s00467-022-05803-y

Surg Today. 2022 Nov 30. doi: 10.1007/s00595-022-02624-2. Online ahead of print.

ABSTRACT

PURPOSE: To assess the impact of surgical approach on morbidity, mortality, and the oncological outcomes of synchronous (SC) and metachronous (MC) colorectal cancer (CRC).

METHODS: All patients undergoing resection for double location CRC (SC or MC) between 2006 and 2020 were included. The exclusion criteria were polyposis or SC located on the same side.

RESULTS: Sixty-seven patients (age, 64.8 years; male, 78%) with SC (n = 41; 61%) or MC (n = 26; 39%) were included. SC was treated with segmental colectomy (right and left colectomy/proctectomy; n = 19) or extensive colectomy (subtotal/total colectomy or restorative proctocolectomy with pouch; n = 22). Segmental colectomy was associated with a higher incidence of anastomotic leakage (47.4 vs. 13.6%; p = 0.04) and a higher rate of medical morbidity (47.4 vs. 16.6%; p = 0.04). The mean number of lymph nodes harvested was similar. For MC, the second cancer was treated by iterative colectomy (n = 12) or extensive colectomy (n = 14) and there was no significant difference in postoperative outcomes between the two surgical approaches. The median follow-up period was 42.4 ± 29.1 months. The 5-year overall and disease-free survival of the SC and MC groups did not differ to a statistically significant extent.

CONCLUSIONS: Extensive colectomy should be preferred for SC to reduce morbidity and improve the prognosis. In contrast, iterative colectomy can be performed safely for patients with MC.

PMID:36449083 | DOI:10.1007/s00595-022-02624-2