Tag: nevin manimala

Urol Oncol. 2022 Apr 21:S1078-1439(22)00107-7. doi: 10.1016/j.urolonc.2022.03.016. Online ahead of print.

ABSTRACT

BACKGROUND: Biomarkers have the potential to provide clinical guidance, but there is limited data for biomarkers in metastatic hormone sensitive prostate cancer (mHSPC).

METHODS: We performed a retrospective multicenter review from Winship Cancer Institute at Emory University and Georgia Cancer Center for Excellence at Grady Memorial Hospital (2014-2020) in the United States of America (USA). We collected demographics, disease characteristics, and laboratory data, including complete blood counts (CBC) at the start of upfront therapy. We evaluated overall survival (OS) and progression-free survival (PFS) associated with baseline lab values.

RESULTS: 165 patients were included with a median follow-up time of 33.5 months (mo). 105 (63.6%) had Gleason scores of 8-10 and 108 (65.9%) were classified as high-volume disease. 92 patients received upfront docetaxel (55.8%) and 73 received upfront abiraterone (44.2%). Univariate analyses (UVA) and multivariable analyses (MVA) identified worse clinical outcomes (CO) associated with elevated basophils and basophil-to-lymphocyte ratio (BLR). Based on MVA, elevated basophils (defined as ≥0.1, optimal cut) were associated with a hazard ratio (HR) of 3.51 (95% CI 1.65-7.43, P 0.001) for OS and HR of 1.88 (95% CI 1.05-3.38, P 0.034) for PFS. Our MVA also found that BLR ≥0.0142 was associated with HR 2.11 (95% CI 1.09-4.10, P 0.028) for OS; however, PFS was not statistically significant.

CONCLUSION: We conclude that elevated baseline basophils and BLR are associated with worse clinical outcomes in mHSPC. Although results require further validation, BLR is a potential prognostic biomarker.

PMID:35466038 | DOI:10.1016/j.urolonc.2022.03.016

Trends Biochem Sci. 2022 Apr 21:S0968-0004(22)00089-5. doi: 10.1016/j.tibs.2022.04.004. Online ahead of print.

ABSTRACT

Proteins are fundamental molecules that mediate diverse biological processes, and protein design can shed light on the molecular mechanisms underlying their biological functions. Huang and colleagues have developed a sequence-independent statistical model for de novo protein design using neural networks (NNs) to learn the distribution of backbone structures with minimal side-chain information.

PMID:35466034 | DOI:10.1016/j.tibs.2022.04.004

Am J Geriatr Psychiatry. 2022 Apr 3:S1064-7481(22)00375-X. doi: 10.1016/j.jagp.2022.03.005. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the associations between the prevalence, treatment, control of hypertension, and trajectories of cognitive performance among Chinese middle-aged and older adults.

DESIGN: An 8-year longitudinal study.

SETTING: China.

PARTICIPANTS: Chinese middle-aged and older adults.

MEASUREMENTS: Data from the China Health and Retirement Longitudinal Study were utilized. Group-based trajectory modeling was performed to identify heterogeneous trajectories of episodic memory and executive function. Multinomial logistic regression models were established to examine the relationships between hypertension status and cognitive trajectories, stratified by sex.

RESULTS: Three episodic memory trajectories and four executive function trajectories were identified in males and females. Hypertension prevalence was associated with worse episodic memory and executive function trajectories in females. Compared with treated hypertensives, untreated hypertensives were more likely to have worse executive function trajectories, both in males and females. Among male treated hypertensives, those with uncontrolled blood pressure (BP) had worse episodic memory trajectories compared with their counterparts with controlled at standard targets, while females with uncontrolled BP demonstrated worse executive function trajectories compared with females controlled at standard targets. There was basically no significant difference in cognitive trajectory memberships between individuals with controlled hypertension corresponding to intensive or standard BP targets.

CONCLUSIONS: The prevalence of hypertension was associated with worse cognitive trajectories, and the treatment and control of hypertension were related to more favorable cognitive trajectories. Intensive BP control target was not associated with additional benefit beyond the recognized protective effect of standard BP targets on cognitive trajectories.

PMID:35466016 | DOI:10.1016/j.jagp.2022.03.005

J Pediatr Nurs. 2022 Apr 21:S0882-5963(22)00098-7. doi: 10.1016/j.pedn.2022.04.008. Online ahead of print.

ABSTRACT

PURPOSE: This present research, mothers of children with chronic illnesses were compared with mothers of children with no chronic illnesses with the aim of determining which factors affect their sleep quality.

DESIGN AND METHODS: The descriptive-type data obtained from this research were collected from 270 mothers of children with chronic illnesses and 197 mothers of healthy children between November 10 and December 10, 2021. All participants were asked to complete a survey. The data were assessed using IBM SPSS Statistics Version 25 and the chi-square test, Fisher’s exact test, t-test, ANOVA (Analysis of Variance), and Logistic Regression Analysis.

RESULTS: The total mean The Pittsburgh Sleep Quality Index (PSQI) score for mothers of chronically ill children was found to be 9.79 ± 3.68 while it was 6.68 ± 3.62 for mothers of heathy children with a statically significant difference (t = 9.075, p = 0.00). The fact that mothers wake up for the care/treatment of their children due to the onset of an illness was found to be associated with poor sleep quality (OR = 0.388 p = 0.017; OR = 0.178, p = 0.000).

CONCLUSIONS: In the present study, it was determined that mothers of children with chronic illnesses suffer from sleep problems and that the sleep quality of those mothers varies depending on the illness types of their children.

PRACTICE IMPLICATIONS: Pediatric nurses are requested to assess the sleep quality of mothers with suitable measurement tools to determine what types of problems affect sleep quality negatively when dealing with children with chronic illnesses in both clinical and non-clinical practices.

PMID:35465997 | DOI:10.1016/j.pedn.2022.04.008

J Hand Surg Am. 2022 Apr 21:S0363-5023(22)00127-7. doi: 10.1016/j.jhsa.2022.02.012. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this randomized trial was to compare the outcomes of using a 3-point prefabricated orthosis with elastic tape versus cast immobilization for the management of nonsurgical mallet finger.

METHODS: This study was conducted in a single center. Individuals with a mallet injury requiring nonsurgical management were randomized to 6 weeks of full-time immobilization with either a 3-point prefabricated orthosis and elastic tape or a cast for distal interphalangeal joint extension. Outcomes were assessed at 12 weeks after the initiation of full-time immobilization and 6 months after injury.

RESULTS: A total of 70 individuals agreed to participate in the study between April 2017 and April 2021. No statistically or clinically significant differences were found between the groups regarding distal interphalangeal joint extension lag, distal interphalangeal joint flexion deficits, function according to the brief Michigan Hand Outcome Questionnaire, and pain on the Numeric Pain Rating Scale. The overall findings for both treatment groups included means of <15° of extensor lag and minimal pain (mean, <1.2 of 10) at the 6-month outcome assessment.

CONCLUSIONS: The use of a 3-point prefabricated orthosis with elastic tape and cast are both appropriate immobilization options for the management of nonsurgical mallet finger.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

PMID:35466009 | DOI:10.1016/j.jhsa.2022.02.012

Eur Urol. 2022 Apr 21:S0302-2838(22)01802-4. doi: 10.1016/j.eururo.2022.03.031. Online ahead of print.

ABSTRACT

CONTEXT: Several recent randomised trials have evaluated the role of combination systemic treatment using androgen deprivation therapy (ADT) plus chemotherapy or an androgen receptor signaling inhibitor (ARSI) in patients with high-risk and/or unfavourable nonmetastatic prostate cancer (nmPC).

OBJECTIVE: To assess the outcomes associated with adding combination systemic treatment to primary definitive local therapy in patients with high-risk and/or unfavourable nmPC.

EVIDENCE ACQUISITION: We queried the PubMed, Web of Science, and Scopus databases and conference abstracts to identify prospective randomised trials examining the value of adding chemotherapy or an ARSI to ADT and primary local therapy with curative intent for nmPC. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and failure-free survival (FFS). Secondary endpoints included adverse events (AEs) and pathologic outcomes.

EVIDENCE SYNTHESIS: We identified 15 randomised studies, of which nine evaluated chemohormonal and six investigated ARSI-based treatment strategies. In both radical prostatectomy (RP) and radiation therapy (RT) settings, addition of docetaxel to ADT was associated with significantly better CSS (pooled hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.49-0.95; p = 0.025), MFS (pooled HR 0.82, 95% CI 0.71-0.95; p = 0.008), and FFS (pooled HR 0.70, 95% CI 0.62-0.79; p < 0.001); the difference did not meet the conventional level of statistical significance for OS (pooled HR 0.86, 95% CI 0.73-1.01; p = 0.072). For patients treated with RT alone, docetaxel-based combination treatment did not meet the significance threshold set for OS (p = 0.3), CSS (p = 0.072), or MFS (p = 0.079), but the difference for FFS was statistically significant (pooled HR 0.72, 95% CI 0.63-0.84; p < 0.001). On network meta-analyses including RT studies, ARSI + ADT outperformed docetaxel + ADT for survival endpoints and had a more favourable AE profile.

CONCLUSIONS: Intensification of systemic therapy with docetaxel or an ARSI in addition to ADT improves oncologic endpoints in high-risk and/or unfavourable nmPC treated with local definitive therapy. The highest efficacy was achieved with ARSI + ADT, specifically in patients treated with RT.

PATIENT SUMMARY: Our findings highlight that selected patients with high-risk nonmetastatic prostate cancer benefit from intensification of systemic therapy beyond hormonal treatment.

PMID:35465985 | DOI:10.1016/j.eururo.2022.03.031

Vaccine. 2022 Apr 18:S0264-410X(22)00474-1. doi: 10.1016/j.vaccine.2022.04.046. Online ahead of print.

ABSTRACT

BACKGROUND: Short-term side effects related to mRNA vaccines against SARS-CoV-2 are frequent and bothersome, with the potential to disrupt work duties and impact future vaccine decision-making.

OBJECTIVE: To identify factors more likely to lead to vaccine-associated work disruption, employee absenteeism, and future vaccine reluctance among healthcare workers (HCWs).

HYPOTHESIS: Side effects related to COVID vaccination: 1- frequently disrupt HCW duties, 2- result in a significant proportion of HCW absenteeism, 3- contribute to uncertainty about future booster vaccination, 4- vary based on certain demographic, socioeconomic, occupational, and vaccine-related factors.

METHODS: Using an anonymous, voluntary electronic survey, we obtained responses from a large, heterogeneous sample of COVID-19-vaccinated HCWs in two healthcare systems in Southern California. Descriptive statistics and regression models were utilized to evaluate the research questions.

RESULTS: Among 2,103 vaccinated HCWs, 579 (27.5%) reported that vaccine-related symptoms disrupted their professional responsibilities, and 380 (18.1%) missed work as a result. Independent predictors for absenteeism included experiencing generalized and work-disruptive symptoms, and receiving the Moderna vaccine [OR = 1.77 (95% CI = 1.33 – 2.36), p < 0.001]. Physicians were less likely to miss work due to side effects (6.7% vs 21.2% for all other HCWs, p < 0.001). Independent predictors of reluctance toward future booster vaccination included lower education level, younger age, having received the Moderna vaccine, and missing work due to vaccine-related symptoms.

CONCLUSION: Symptoms related to mRNA vaccinations against SARS-CoV-2 may frequently disrupt work duties, lead to absenteeism, and impact future vaccine decision-making. This may be more common in Moderna recipients and less likely among physicians. Accordingly, health employers should schedule future booster vaccination cycles to minimize loss of work productivity.

PMID:35465979 | DOI:10.1016/j.vaccine.2022.04.046

J Prosthet Dent. 2022 Apr 21:S0022-3913(22)00200-1. doi: 10.1016/j.prosdent.2022.03.020. Online ahead of print.

ABSTRACT

STATEMENT OF PROBLEM: The disinfection of removable dental prostheses and orthodontic appliances is essential to preventing transmission of pathogens. However, whether different disinfection solutions and durations affect the physical properties of denture base resins is unclear.

PURPOSE: The purpose of this systematic review and meta-analysis was to statistically analyze the influence of disinfectants on the physical properties of denture base resins.

MATERIAL AND METHODS: A systematic search in Medline, Embase, PubMed, and Cochrane Library databases was conducted to evaluate the effects of chemical disinfection on the physical properties of denture base resins such as surface morphology, roughness, hardness, and flexural strength. Of 1909 studies, 44 studies were included in the systematic review and 41 in the meta-analysis. Heterogeneity was analyzed by using I² statistics. The influence of different disinfection solutions and durations on the physical properties was further analyzed, and the risk of bias evaluated. Statistical analyses were performed by using the RevMan 5.4 software program with the standardized mean differences (SMDs) and 95% confidence intervals (CIs).

RESULTS: Of the 44 included studies, 40 studies were assessed as having a low risk of bias, and 4 had an unclear risk of bias. Meta-analysis results showed that compared with the control, disinfection could not significantly affect surface roughness and hardness within 60 minutes of immersion in disinfectant solutions or flexural strength within 30 minutes (roughness: P=.79, I²=0%; flexural strength: P=.08, I²=0%; hardness: P=.05, I²=19%). In addition, the physical properties were not significantly affected when glutaraldehyde, chlorhexidine, and peracetic acid were repeatedly used for more than 30 minutes.

CONCLUSIONS: Most of the disinfectants did not reduce the physical properties of denture base resin within 30 minutes of immersion. Glutaraldehyde, chlorhexidine, and peracetic acid are recommended if longer immersion or repeated disinfection is required.

PMID:35465961 | DOI:10.1016/j.prosdent.2022.03.020

Neurologia (Engl Ed). 2022 Apr;37(3):199-215. doi: 10.1016/j.nrleng.2020.05.004. Epub 2020 May 24.

ABSTRACT

INTRODUCTION: A growing number of studies have evaluated the effects of transcranial magnetic stimulation (TMS) for the symptomatic treatment of multiple sclerosis (MS).

METHODS: We performed a PubMed search for articles, recent books, and recommendations from the most relevant clinical practice guidelines and scientific societies regarding the use of TMS as symptomatic treatment in MS.

CONCLUSIONS: Excitatory electromagnetic pulses applied to the affected cerebral hemisphere allow us to optimise functional brain activity, including the transmission of nerve impulses through the demyelinated corticospinal pathway. Various studies into TMS have safely shown statistically significant improvements in spasticity, fatigue, lower urinary tract dysfunction, manual dexterity, gait, and cognitive deficits related to working memory in patients with MS; however, the exact level of evidence has not been defined as the results have not been replicated in a sufficient number of controlled studies. Further well-designed, randomised, controlled clinical trials involving a greater number of patients are warranted to attain a higher level of evidence in order to recommend the appropriate use of TMS in MS patients across the board. TMS acts as an adjuvant with other symptomatic and immunomodulatory treatments. Additional studies should specifically investigate the effect of conventional repetitive TMS on fatigue in these patients, something that has yet to see the light of day.

PMID:35465914 | DOI:10.1016/j.nrleng.2020.05.004

Br J Anaesth. 2022 Apr 21:S0007-0912(22)00139-8. doi: 10.1016/j.bja.2022.03.015. Online ahead of print.

ABSTRACT

BACKGROUND: Preoperative frailty may predispose patients to poorer outcomes in cardiac surgery; however, there are limited data concerning how preoperative frailty predicts patient-centred outcomes, such as patient-reported disability. Our objective was to evaluate the association between preoperative frailty and postoperative disability.

METHODS: Patients were prospectively evaluated using the Comprehensive Assessment of Frailty score, separating patients into frail and non-frail cohorts. Disability levels were quantified using the WHO Disability Assessment Schedule (WHODAS) 2.0 in percentage of the maximum disability score, with disability defined as a value ≥25%.

RESULTS: Frail patients had increased median [inter-quartile range] disability scores of 31 [16-45]% preoperatively, 29 [9-54]% at 1 month, and 15 [3-31]% at 3 months postoperatively, compared with disability scores in non-frail patients of 10 [5-17]%, 17 [6-29]%, and 2.1 [0-12.0]%, respectively. Preoperative frailty was associated with a reduced likelihood of patients being free of disability and alive at 3 months; adjusted odds ratio 0.51 (for age, European System for Cardiac Operative Risk Evaluation II, and WHODAS 2.0: 12-Part Questionnaire score); P=0.045. The trajectory of disability scores, assessed in percentage change from the preoperative baseline, showed non-frail patients had increased disability burden at 1 month, whereas frail patients had reduced disability burden (+4.2% vs -2.1%; P=0.04). Although the disability burden decreased for both groups at 3 months, this was most marked for frail patients (-6.3% vs -10.4%; P=0.02).

CONCLUSIONS: Disability burden in frail patients improves continuously postoperatively, whereas in non-frail patients, it worsens at 1 month before improving at 3 months postoperatively. This positive trajectory of patient-centred outcomes in frail patients should be considered in preoperative decision-making.

PMID:35465950 | DOI:10.1016/j.bja.2022.03.015