Tag: nevin manimala

Nurs Res. 2021 Mar 22. doi: 10.1097/NNR.0000000000000513. Online ahead of print.

ABSTRACT

BACKGROUND: Despite numerous efforts to create more equitable health care systems, minority populations face long-standing health disparities compared to White populations. Health care research is the necessary foundation for creating equitable health systems and providing patient-centered care. Significant challenges exist, however, with recruiting and engaging underrepresented populations in clinical research.

OBJECTIVES: The purpose of this analysis was to determine how research participant race, trust, and level of education influence participation barriers in clinical research.

METHODS: The study used secondary, cross-sectional survey data that were collected between 2014 and 2016 through the former Mid-South Clinical Data Research Network (CDRN), currently known as the STAR-CRN. Descriptive statistics and Spearman rank correlations were performed between level of education, level of trust, and each attitude statement for each racial category.

RESULTS: A total of 2,190 survey responses were used in the data analysis. The mean age of respondents was 52 years with majority being female, White, insured, and working full time. Overall, the respondents had favorable attitudes towards research participation. Trust was correlated with agreement in many attitude statements for both White and African American respondents, while correlations with education level were more variable depending on racial grouping. Trust level was negatively associated with agreement towards the statement “researchers don’t care about me” in White and Native American respondents.

DISCUSSION: The results support the importance of trust to research participation. Generally, education level was not strongly predictive of research participation, although prediction was influenced by race and attitude.

PMID:33883501 | DOI:10.1097/NNR.0000000000000513

Shokuhin Eiseigaku Zasshi. 2021;62(2):56-64. doi: 10.3358/shokueishi.62.56.

ABSTRACT

Benchmark dose (BMD) method have been used in the toxicological assessment of chemical substances so that the point of departure can be derived, as an alternative to the use of no observable adverse effect level (NOAEL), and the method is often applied to the incidence data of histopathological findings in the toxicity studies. In the present study, the BMD method was applied to various patterns of incidence data derived from some toxicity studies as case studies, and the validity of each application was discussed. Five independent applications including toxicity studies of madder color or semicarbazide hydrochloride were prepared and model averaging over the three models with the lowest three AIC (Akaike information criteria) values (MA-3), a recently proposed model averaging method, was employed. The series of case studies indicated, for the better application of the BMD method to histopathological findings, the following points:(i) If there are incidence data with severity grading of pathologically significant lesions, we must discuss whether the BMD method should be applied to the total incidence data or the incidence data above certain grade with or without data aggregation.(ii) If a lesion of interest had higher toxicological significance rather than the secondary lesions with higher severity, the BMD method should be applied to the incidence data of the lesion of interest.(iii) If it is highly necessary to apply the BMD method to obtained incidence data without toxicological and statistical validity, toxicological pathologists are advised to review individual datasets of histopathology and associated data, and provide new incidence data of comprehensive findings (diagnostic name) such as hepatocellular injury or nephropathy, if possible. In all cases, toxicological significance and mechanism of a lesion of interest need to be considered in light of the dose-dependence. In view of both toxicology and statistics, sufficient discussions must be made on the validity of applying BMD method and its estimate.

PMID:33883337 | DOI:10.3358/shokueishi.62.56

Ann Plast Surg. 2021 Apr 21. doi: 10.1097/SAP.0000000000002857. Online ahead of print.

ABSTRACT

INTRODUCTION: In the last decade, we have seen a steady increase in the incidence of frontal sinus trauma due to gunshot wounds and a decrease in motor vehicle trauma. Penetrating gunshot wounds to the frontal sinus present a unique challenge to the reconstructive surgeon because they require careful consideration of the management principles of plastic surgery. Despite previous reviews on frontal sinus trauma, there are no studies examining the management techniques of frontal sinus fractures due specifically to gunshot wounds. In this study, we aim to retrospectively evaluate the use of a variety of tissue flaps in intervention and associated outcomes.

METHODS: A retrospective chart review was completed on all patients with gunshot wound(s) to the frontal sinus from January 2010 to January 2018 at a single institution. The patients were classified based on the fracture pattern (anterior vs posterior table vs both), degree of displacement, presence of nasofrontal outflow tract injury, and evidence of cerebrospinal fluid leak. Patients were then stratified according to the type of reconstruction performed (cranialization, obliteration and need for free flap) and evaluated for major and minor complications after reconstruction.

RESULTS: In this study, we present outcome data from 28 cases of frontal sinus trauma due to gunshot wounds. There was a statistically significant difference (P = 0.049) in the type reconstructive strategy employed with each type of flap, with pericranial flaps primarily used in cranialization, temporal grafts were more likely to be used in obliteration, and free flaps were more likely to be used in cranialization. The overall major complication rate was 52% (P = 0.248), with the most common acute major complication was cerebrospinal fluid leak (39%) and major chronic was abscess (23.5%).

CONCLUSIONS: This report explores the management of frontal sinus trauma and presents short-term outcomes of treatment for penetrating gunshot wounds at a tertiary referral center.

PMID:33883442 | DOI:10.1097/SAP.0000000000002857

Cancer Nurs. 2021 Apr 21. doi: 10.1097/NCC.0000000000000932. Online ahead of print.

ABSTRACT

BACKGROUND: Sleep disturbance is common among adolescent and young adult (AYA) cancer survivors. Physical activity (PA) and behavioral activation (BA) therapy have been reported as enhancing sleep quality, but few studies exist on the effects of such interventions combined with technology to promote sleep quality in AYA cancer patients.

OBJECTIVE: The aim of this study was to investigate the feasibility and effects of intelligent wearable device-based PA therapy and internet-based modified BA therapy to improve sleep quality among AYA cancer patients.

METHODS: A randomized controlled trial with 143 AYA cancer patients was conducted. Participants were randomly assigned to a control group (n = 48), which performed routine care, a PA group (n = 47), which received 8-week PA therapy based on intelligent wearable devices, and a BA group (n = 48), which participated in internet-based modified BA therapy for 8 weeks.

RESULTS: At 1 week and 3 months after the intervention for sleep quality, there were statistically significant differences between the PA group and the control group (P = .020), but no statistically significant difference between the BA group and the control group.

CONCLUSIONS: The intelligent wearable device-based PA therapy has more advantages than internet-based modified BA therapy in improving the overall state of AYA cancer patients, and the intervention effect was sustained for at least 3 months.

IMPLICATIONS FOR PRACTICE: Developing and implementing PA plans for AYA cancer survivors can improve their sleep quality. Social media, intelligent wearable devices, and mobile health applications have unique advantages in promoting sleep quality for AYA cancer survivors.

PMID:33883477 | DOI:10.1097/NCC.0000000000000932

Neurology. 2021 Apr 21:10.1212/WNL.0000000000011986. doi: 10.1212/WNL.0000000000011986. Online ahead of print.

ABSTRACT

OBJECTIVE: Migraine has been identified as a potential risk-factor for hypertension in prospective studies. In women, migraine prevalence decreases after menopause, but no studies have determined if migraine is associated with hypertension after menopause. This study sought to determine if history of migraine was associated with an increased risk of hypertension among menopausal women.

METHODS: We assessed associations between migraine and hypertension in a longitudinal cohort study of 56,202 menopausal women participating in the French E3N cohort, with follow-up beginning in 1993. We included women who did not have hypertension or cardiovascular disease at the age of their menopause. Migraine was classified as ever or never at each questionnaire cycle. Cox proportional hazards models were used to investigate relations between migraine and hypertension, controlling for potential confounding. A secondary analysis with baseline in 2011 considered aura status, grouping participants reporting migraine as migraine with aura, migraine without aura, or unknown migraine type.

RESULTS: During 826,419 person years, 12,501 cases of incident hypertension were identified, including 3100 among women with migraine, and 9401 among women without migraine. Migraine was associated with an increased risk of hypertension in menopausal women (HR _migraine = 1.29 [1.24: 1.35]), and were consistent in post-hoc sensitivity analyses, such as when controlling for common migraine medications. Associations between migraine and hypertension were similar whether or not women reported aura (HR _{migraine aura} = 1.54 [1.04: 2.30], HR _{migraine no aura} = 1.32 [0.87: 2.02], p-heterogeneity = 0.60). Associations were slightly stronger among ever users of menopausal hormone therapy (HR _migraine = 1.34 [1.27: 1.41]), than among never users (HR _migraine = 1.19 [1.11: 1.28]).

CONCLUSION: Migraine was associated with an increased risk of hypertension amongst menopausal women. In secondary analysis, we didn’t observe a significant difference between migraine with aura and migraine without aura.

PMID:33883242 | DOI:10.1212/WNL.0000000000011986

J Sport Rehabil. 2021 Apr 20:1-4. doi: 10.1123/jsr.2020-0448. Online ahead of print.

ABSTRACT

Clinical Scenerio: Neck pain is a costly symptom in both civilian and military worlds. While traditional treatments include deep neck flexor stabilizing exercises, manual therapy, electrical therapy, and other nonsurgical interventions, scapular orientation and stability training has emerged as a possible tool to reduce neck pain severity. Methods that can be coached at a distance could be of value in virtual appointments or circumstances where access to a qualified manual therapist is limited. Focused Clinical Question: What is the effectiveness of including exercise programs targeting scapular kinematics and stability to decrease neck pain? Summary of Key Findings: Exercise programs targeting scapular kinematics and stability, with coaching and individualized progressions, appear to reduce neck pain severity. Clinical Bottom Line: Evidence supports the inclusion of exercises for scapular kinematics and stability at a prescription of 3 sessions per week, with a duration of 4 or 6 weeks. Exercise programs should include a “learning” or coaching phase to ensure exercises are performed as intended, and exercise progressions should be based on participant ability rather than predetermined timelines. Further research is needed to better understand the benefits of this potential strategy and the statistical impact of scapular-focused exercise interventions on neck pain in specific populations like military and athletes. Strength of Recommendation: There is ‘Fair’ to ‘Good’ evidence from 2 level 1b single-blind randomized control studies and 1 level 2b pre-post test control design study supporting the inclusion of exercise programs targeting scapular kinematics and stability to decrease chronic neck pain severity.

PMID:33883300 | DOI:10.1123/jsr.2020-0448

Clin Cancer Res. 2021 Apr 21:clincanres.0159.2021. doi: 10.1158/1078-0432.CCR-21-0159. Online ahead of print.

ABSTRACT

PURPOSE: Small bowel adenocarcinoma (SBA) is rare, and no standard of care exists for metastatic disease beyond first-line FOLFOX/CAPOX. SBA has higher rates of microsatellite instability (MSI-H) and T-lymphocyte infiltration than other gastrointestinal cancers. We hypothesize that pembrolizumab, a PD-1 inhibitor, will induce antitumor response.

PATIENTS AND METHODS: Previously treated advanced SBA patients received pembrolizumab 200 mg IV q3 weeks until disease progression (PD), toxicity, or 35 dose maximum. Primary endpoint was confirmed overall response rate (ORR) with secondary progression free survival (PFS), overall survival (OS), and toxicity assessment endpoints. Outcomes were stratified by tumor location, microsatellite stability (MSS) or instability (MSI-H), and PD-L1 level.

RESULTS: 40 patients were treated for a median duration of 4 cycles (range 1-35). All patients are off study treatment due to: PD (75%), death (10%), 35 cycles completed (8%), refusal (3%), and adverse effects (AE, 5%). Three confirmed partial responses (PR) (8%; 95% CI: 2-20) did not meet pre-defined success criteria of ORR 30%. Median OS 7.1 mo (95% CI: 5.1-17.1) and median PFS 2.8 mo (95% CI: 2.7-4.2) were similar across primary tumor sites. One confirmed PR (3%) was seen in MSS/MSI-low patients and correlated with high tumor mutation burden (TMB). 50% of MSI-H patients achieved PR and remain alive without progression. 25 patients (63%) had grade >=3 AEs, 11 pts (28%) had grade 4/5 AEs.

CONCLUSIONS: In the largest study of SBA to date, pembrolizumab did not induce the hypothesized response rate; however, we did identify responses in key biomarker-selected cohorts.

PMID:33883178 | DOI:10.1158/1078-0432.CCR-21-0159

Diabetes Care. 2021 Apr 21:dc202388. doi: 10.2337/dc20-2388. Online ahead of print.

ABSTRACT

OBJECTIVE: The role of genetic factors in the risk of cardiovascular disease (CVD) for patients with type 1 diabetes (T1D) remains unknown. We therefore examined whether previously identified genetic factors for coronary artery disease (CAD) are associated with the risk of CVD above and beyond established demographic and clinical factors in the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study.

RESEARCH DESIGN AND METHODS: Polygenic risk scores (PRS) and individual genetic variants identified in previous studies were obtained from genome-wide genotyping performed in 1,371 DCCT/EDIC participants. Two composite CVD outcomes were considered: major adverse cardiovascular events (MACE) (CVD death or nonfatal myocardial infarction [MI] or stroke) and any CVD (MACE plus confirmed angina, silent MI, revascularization, or congestive heart failure). Cox proportional hazards models assessed the association between the genetic factors and the risk of CVD with adjustment for other factors (including age, lipids, blood pressure, and glycemia).

RESULTS: CAD PRS was strongly associated with the subsequent risk of any CVD (42% and 38% higher risk per 1-SD increase in unadjusted and fully adjusted models, respectively; P < 0.0001) and with the risk of MACE (50% and 40% higher risk per 1-SD increase in unadjusted and fully adjusted models, respectively; P < 0.0001). Several individual single nucleotide polymorphisms were also nominally associated with the risk of any CVD and MACE.

CONCLUSIONS: Genetic factors are associated with the risk of subsequent CVD in individuals with T1D above and beyond the effect of established risk factors such as age, lipids, blood pressure, and glycemia.

PMID:33883194 | DOI:10.2337/dc20-2388

J Neurosci. 2021 Apr 20:JN-RM-3238-20. doi: 10.1523/JNEUROSCI.3238-20.2021. Online ahead of print.

ABSTRACT

Animal studies suggest that cochlear nerve degeneration precedes sensory cell degeneration in both noise-induced hearing loss (NIHL) and age-related hearing loss (ARHL), producing a hearing impairment that is not reflected in audiometric thresholds. Here, we investigated the histopathology of human ARHL and NIHL by comparing loss of auditory nerve fibers (ANFs), cochlear hair cells and the stria vascularis in a group of 52 cases with noise-exposure history against an age-matched control group. Although strial atrophy increased with age, there was no effect of noise history. Outer hair cell (OHC) loss also increased with age throughout the cochlea but was unaffected by noise history in the low-frequency region (<2 kHz), while greatly exacerbated at high frequencies (≥2 kHz). Inner hair cell (IHC) loss was primarily seen at high frequencies but was unaffected by noise at either low or high frequencies. ANF loss was substantial at all cochlear frequencies and was exacerbated by noise throughout. According to a multivariable regression model, this loss of neural channels contributes to poor word discrimination among those with similar audiometric threshold losses. The histopathological patterns observed also suggest that, whereas the low-frequency OHC loss may be an unavoidable consequence of aging, the high-frequency loss, which produces the classic down-sloping audiogram of ARHL, may be partially because of avoidable ear abuse, even among those without a documented history of acoustic overexposure.Statement of SignificanceAs regenerative therapeutics in sensorineural hearing loss enter clinical trials, it becomes critical to infer which cochlear pathologies are present in addition to hair cell loss. Here, by analyzing human autopsy material, we show that acoustic injury accelerates age-related primary neural degeneration, but not strial degeneration, neither of which can be inferred from audiometric thresholds. It exacerbates outer hair cell (OHC) loss only in the high-frequency half of the cochlea, suggesting that the apical loss is age-related, whereas the basal loss is partially noise induced, and therefore avoidable. Statistical analysis suggests that neural loss helps explain differences in word-recognition ability among individuals with similar audiometric thresholds. The surprising correlation between neural loss and OHC loss in the cochlea’s speech region also implicates neural loss in the well-known decline in word scores as thresholds deteriorate with age.

PMID:33883202 | DOI:10.1523/JNEUROSCI.3238-20.2021

Sci Adv. 2021 Apr 21;7(17):eabg4755. doi: 10.1126/sciadv.abg4755. Print 2021 Apr.

ABSTRACT

Single-cell RNA sequencing (scRNA-seq) of tissues has revealed remarkable heterogeneity of cell types and states but does not provide information on the spatial organization of cells. To better understand how individual cells function within an anatomical space, we developed XYZeq, a workflow that encodes spatial metadata into scRNA-seq libraries. We used XYZeq to profile mouse tumor models to capture spatially barcoded transcriptomes from tens of thousands of cells. Analyses of these data revealed the spatial distribution of distinct cell types and a cell migration-associated transcriptomic program in tumor-associated mesenchymal stem cells (MSCs). Furthermore, we identify localized expression of tumor suppressor genes by MSCs that vary with proximity to the tumor core. We demonstrate that XYZeq can be used to map the transcriptome and spatial localization of individual cells in situ to reveal how cell composition and cell states can be affected by location within complex pathological tissue.

PMID:33883145 | DOI:10.1126/sciadv.abg4755