Tag: pubmed

Psychooncology. 2024 Nov;33(11):e70010. doi: 10.1002/pon.70010.

ABSTRACT

OBJECTIVE: Cancer patients generally have high stress levels, which often leads to depression, anxiety and other psychological problems. Laughter therapy has been used to relieve stress, depression and anxiety in cancer patients, but its efficacy is uncertain. The study aims to summarize evidence on the efficacy of laughter therapy on psychological symptoms of people with cancer.

METHODS: A search was conducted in 10 electronic databases for randomized controlled trials (RCTs) reported before May 2023. This systematic review was reported based on the PRISMA 2020 statement. The evaluation of methodological quality and risk of biases were conducted by the Cochrane Risk of Bias Assessment tool version 2, and evidence evaluation was conducted using the GRADE pro online assessment tool. Statistical analysis adopted the Review Manager version 5.4 software.

RESULTS: A total of eight studies were included involving 543 participants. Meta-analysis showed that laughter therapy plus routine nursing produced more positive effects than routine nursing in relieving stress (SMD = -1.18, 95% CI -1.73, -0.62, p < 0.0001), depression (SMD = -1.05, 95% CI -1.30, -0.81, p < 0.00001) and anxiety (SMD = -0.81, 95% CI -1.20, -0.43, p < 0.0001).

CONCLUSIONS: Laughter therapy could effectively relieve stress, depression and anxiety of cancer patients. Future studies should improve the methodological quality of randomized controlled trials, conduct appropriate follow-up, and report details of follow-up. Additionally, it should perform multi-center and large-sample studies, and combine both subjective and objective outcome indications to enhance the persuasiveness of evidence supporting the effectiveness of laughter therapy.

TRIAL REGISTRATION: PROSPERO register: CRD 42023452739.

PMID:39472305 | DOI:10.1002/pon.70010

Musculoskeletal Care. 2024 Dec;22(4):e70004. doi: 10.1002/msc.70004.

ABSTRACT

BACKGROUND: Access to general practitioner (GP) services is essential for managing musculoskeletal pain. This study investigates the relationship between patient demographics, co-morbidities, health behaviours and difficulty in accessing GP services in the United Kingdom. Significant associations were explored between age, co-morbidities and ease of securing GP appointments. This analysis provides insights into the barriers patients face and suggests targeted interventions for improving access to primary care.

METHODS: A cross-sectional study was conducted using survey data from participants of various ages, ethnicities and socioeconomic statuses with either localised or generalised musculoskeletal pain. Relationships between key variables, such as age, co-morbidities and difficulty in accessing GP services, were examined using chi-square tests (for nominal variables) and Kruskal-Wallis tests (for nominal and ordinal variables).

RESULTS: A total of 503 respondents participated in the online questionnaire. In all, 66% of the respondents were female. The majority of participants were Caucasian (69%), followed by South Asians (19%), with the remainder identifying as Black or of mixed ethnicity. Most respondents (62%) reported experiencing musculoskeletal pain for over 2 years. Significant associations were found between the age of the participants and difficulty in accessing GP services (χ²(20) = 39, p = 0.006), co-morbidities and the impact of delayed GP reviews on patients’ musculoskeletal pain (χ²(10) = 31, p = 0.001), employment status and alternative care choices (χ²(4) = 10.99, p = 0.027).

CONCLUSION: These results highlight the multifaceted nature of healthcare access for patients of various ages with musculoskeletal pain. Age, co-morbidities and employment status significantly influence access to GP services. Future studies should explore additional systemic healthcare barriers and develop personalised interventions to improve access for high-risk populations.

PMID:39472287 | DOI:10.1002/msc.70004

Physiol Rep. 2024 Nov;12(21):e70117. doi: 10.14814/phy2.70117.

ABSTRACT

Previous studies based on animal models have raised concerns about salbutamol use in ozone air pollution with regard to ozone related lung injury. We conducted a double-blind, randomized, placebo-controlled crossover study including 18 subjects diagnosed with EIB by a eucapnic voluntary hyperpnea (EVH) test. Participants completed 30 min of standardized moderate to vigorous exercise in four conditions: ozone plus salbutamol; room air plus salbutamol; ozone plus placebo medication; and room air plus placebo medication. Spirometry, fraction of exhaled nitric oxide, and symptoms were measured before, immediately after, 30 min after and 1 h after exercise. Measurements between the four conditions were compared using percent change from pre to post exercise. There was a statistically significant difference between the salbutamol and placebo medication groups for spirometric variables including FEV1 (Estimate = 6.3, 95% CI: 4.23-8.37, p < 0.001). No differences were observed between ozone and room air exposures. There were no significant differences in FeNO response between experimental conditions. We found that salbutamol improved pulmonary function in individuals with EIB when exercising in ozone and did not increase eosinophilic airway inflammation as indicated by FeNO. This evidence suggests that it is safe for people with EIB to continue to use salbutamol as proscribed when ozone levels are elevated.

PMID:39472279 | DOI:10.14814/phy2.70117

Surgery. 2024 Oct 28:S0039-6060(24)00832-8. doi: 10.1016/j.surg.2024.08.054. Online ahead of print.

ABSTRACT

BACKGROUND: Inguinal hernia repair is one of the most common surgical procedures in the world. Each repair technique, open, laparoscopic, and robotic, has its advantages and advocates. Prior studies have compared 2 techniques, but there are little data comparing all 3 approaches with long-term follow-up.

METHODS: Prospectively collected data for unilateral inguinal hernia repair between 2007 and 2022 were reviewed. Using more than 3,300 inguinal hernia repairs, a 1:1:1 propensity score match was performed for open inguinal hernia repair, laparoscopic inguinal hernia repair, and robotic inguinal hernia repair based on patient age, sex, body mass index, and laterality. Standard descriptive and comparative statistics were performed. Data below is reported consistently as open inguinal hernia repair versus laparoscopic inguinal hernia repair versus robotic inguinal hernia repair.

RESULTS: A total of 420 patients were matched, with 140 in each group. There was no difference in age, body mass index, or smoking status between groups. Open inguinal hernia repair had significantly more comorbidities (2.8 vs 2.6 vs 2.3; P = .035), including higher rates of chronic obstructive pulmonary disease (5.0% vs 0.0% vs 1.4%; P = .013), cirrhosis (4.3% vs 0.0% vs 1.4%; P = .032), and congestive heart failure (5.0% vs 0.7% vs 0.7%; P = .023). American Society of Anesthesiologists scores differed significantly between groups (stage III and IV: 35.0% vs 20.0% vs 28.6%; P = .004). Open inguinal hernia repair were more often recurrent (48.6% vs 27.9% vs 17.1%; P < .001). The mean operative time was significantly different between groups (88.0 vs 86.1 vs 101.4 minutes; P < .001). There was no difference in wound infection (0.7% vs 0.0% vs 0.0%; P > .99), hematoma (1.4% vs 0.7% vs 1.4%; P > .99), seroma requiring intervention (2.9% vs 0.7% vs 0.7%; P = .377), or readmission (0.0% vs 2.1% vs 1.4%; P = .378). The rate of prolonged discomfort, requiring more than 2 pain medication refills, was similar between groups (2.9% vs 2.1% vs 2.1%; P = .903). Robotic inguinal hernia repair was significantly more expensive than laparoscopic inguinal hernia repair and open inguinal hernia repair ($10,005 ± $7,050 vs $17,155 ± $6,702 vs $31,173 ± $8,474; P < .001). With follow-up of at least 2.4 years in each group (3.6 vs 4.8 vs 2.4 years; P < .001), the recurrence rate was comparable (3.6% vs 0.7% vs 0.7%; P = .226).

CONCLUSIONS: All techniques are safe and effective in qualified hands. Open inguinal hernia repair was more commonly used in comorbid patients and recurrent hernias, but the techniques had comparable rates of wound complications, postoperative prolonged discomfort, and recurrence.

PMID:39472265 | DOI:10.1016/j.surg.2024.08.054

Int Dent J. 2024 Oct 28:S0020-6539(24)01544-2. doi: 10.1016/j.identj.2024.09.031. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study is to investigate risk factors for external root resorption (ERR) of second molars (M2) associated with impacted third molars (M3), and to develop a prediction model that can offer dentists a reliable and efficient tool for predicting the likelihood of ERR.

METHODS: A total of 798 patients with 2156 impacted third molars were collected from three centres between 1 December 2018 and 15 December 2018. ERR was identified by cone beam computed tomography examinations. The effects of different risk factors on the presence/absence of ERR and its severity were analysed using Chi-square or Fisher test. Multivariate logistic regressive analysis with stepwise variable selection methods was performed to identify factors which were significant predictors for ERR and its severity. Subsequently, a prediction model was developed, and the model performance was validated internally and externally.

RESULTS: The overall incidence of ERR of second molars was 16.05%. The prediction model was established using six factors including position (upper/lower jaw), impact type, impact depth (PG: A-B-C), contact position, root number of M3, and age. In terms of internal validation, the prediction model demonstrated satisfactory performance, achieving an area under curve of 0.961 and a prediction accuracy of 0.907. As for external validation, the area under curve remained high at 0.953, with a prediction accuracy of 0.892.

CONCLUSION: A risk prediction model for ERR was established in the present study. Position (upper or lower jaw), impact type, impact depth (PG: A-B-C), contact position, root number of M3, and age were identified as influencing variables which were significant predictors in the development of this predictive model. The prediction model showed great discrimination and calibration.

CLINICAL RELEVANCE: This prediction model has the potential to aid dentists and patients in making clinical decisions regarding the necessity of M3 extraction.

PMID:39472249 | DOI:10.1016/j.identj.2024.09.031

Oral Surg Oral Med Oral Pathol Oral Radiol. 2024 Aug 9:S2212-4403(24)00401-2. doi: 10.1016/j.oooo.2024.07.008. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients exposed to a combination of antiresorptive medication and radiotherapy of the head and neck area developing necrosis of the jaw in the course of treatment are extremely rare. Therefore, the aim of this study was to identify the outcome and complications in this highly vulnerable patient cohort.

STUDY DESIGN: Seventeen patients who received both antiresorptive treatment and radiotherapy (medication-related osteonecrosis of the jaw/osteoradionecrosis = the [MRONJ/ORN] group) in the head and neck area were enrolled in this study. Included patients were treated in our department between 2005 and 2022. Four hundred twenty-four patients with MRONJ (the MRONJ group) and 138 patients with ORN of the jaw were enrolled as two control groups (the ORN group). Demographic data, lesion localization, date of primary diagnosis, clinical symptoms, type of therapy (surgical or non-surgical), details on antiresorptive treatment, outcome, and complications were recorded.

RESULTS: Pathological fractures, continuity resection, and recurrence appear more often in patients who receive a combination of antiresorptive treatment and radiotherapy in the head and neck area compared with patients undergoing only one of these treatments. There was a statistically significant difference (P < .001) between the MRONJ/ORN group and the MRONJ group and the MRONJ/ORN group and the ORN group considering recurrence, fracture, and continuity resection. Patients with ORN combined with MRONJ have a 4-times higher risk for developing recurrence compared with patients with MRONJ and a 1.5-times higher risk for recurrence compared with patients with ORN. Jaw fracture and continuity resection appear more often in patients with MRONJ/ORN.

CONCLUSIONS: Patients under antiresorptive therapy in combination with radiation therapy in the head and neck area have a higher risk for developing complications in case of osteonecrosis of the jaw. Therefore, a strict follow-up care schedule is highly recommended.

PMID:39472248 | DOI:10.1016/j.oooo.2024.07.008

J Pediatr Surg. 2024 Oct 20:162024. doi: 10.1016/j.jpedsurg.2024.162024. Online ahead of print.

ABSTRACT

AIM OF THE STUDY: This study aimed to evaluate contemporary management strategies of pediatric renal trauma, focusing on the failure of conservative management and identifying its predictors.

METHODS: The National Trauma Database (2018-2021) was queried for pediatric patients (≤18 years) with renal injury, identified via AIS codes aligned with the AAST kidney injury grading system. Urological surgical procedures were identified via ICD-10 Procedure Codes. Patients were categorized into immediate surgical management (within 4 h), conservative management (no surgery), and failed conservative management (surgery after 4 h). Demographics, injury characteristics, and clinical data were analyzed using descriptive and univariate statistical analyses (Wilcoxon Rank Sum, Chi-square, Odds Ratios).

RESULTS: Of 7266 pediatric renal trauma patients, most were white (63.4 %) males (69.1 %), aged 12-18 (76.6 %), suffering from unintentional blunt trauma (86.9 %). Most (n = 6610, 95 %) received conservative management; however, 4.5 % (n = 298) failed. Common surgical interventions included ureteral stent placement (n = 200, 59 %), renal IR procedures (n = 44, 13 %), and nephrectomy (n = 33, 9.7 %). Nephrectomy rates at low AAST kidney injury grades (I-II) were higher with upfront surgical management (n = 7, 3.5 %) than with failed conservative management (n = 0). Predictors of failed conservative management included higher Injury Severity Score (ISS) and higher AAST kidney injury grades (III-V) (p < 0.05).

CONCLUSION: Conservative management failed in 4.5 % of paediatric renal trauma cases, associated with higher AAST kidney injury grade and ISS. Upfront surgical management correlated with a higher nephrectomy rate at lower injury grades compared to failed conservative management. Refinement of pediatric trauma protocols is needed for optimal care.

LEVEL OF EVIDENCE: III.

PMID:39472232 | DOI:10.1016/j.jpedsurg.2024.162024

J Cyst Fibros. 2024 Oct 28:S1569-1993(24)01801-0. doi: 10.1016/j.jcf.2024.10.006. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to characterize the uptake of elexacaftor/tezacaftor/ivacaftor (ETI) following Food and Drug Administration (FDA) approval in October 2019.

METHODS: People with cystic fibrosis (PwCF) ≥12 years enrolled in the CF Foundation Patient Registry (CFFPR) from 2019-2022 with at least one copy of F508del were included. We calculated summary statistics according to ETI prescription status. We used a Kaplan-Meier estimator to determine median days to ETI prescription to identify differences in prescription uptake by lung function, race, and ethnicity and a Cox proportional hazards model to identify risk factors associated with timing of first ETI prescription.

RESULTS: A total of 17,183 people (91 %) were prescribed ETI. The median time to prescription was 121 days (95 % CI: 119, 122), with 75 % prescribed within 311 days (95 % CI: 301, 325). PwCF prescribed ETI were younger, had lower lung function, more pulmonary exacerbations in the prior year, earlier age of diagnosis, and were more likely to have been prescribed another CFTR modulator (if eligible). Public health insurance, ppFEV₁ >90, Black race and Hispanic ethnicity were associated with lower hazards (e.g., later) of ETI prescription whereas prior modulator prescription, pancreatic insufficiency, increased exacerbation frequency and prior infections were associated with a higher hazard (earlier) of prescription.

CONCLUSIONS: While over 90 % of eligible individuals were prescribed ETI within three years, time of first prescription was associated with demographic factors and disease severity. Further research should investigate the reasons for this delay and approaches to reduce time to initiation for ETI and future therapies.

PMID:39472230 | DOI:10.1016/j.jcf.2024.10.006

Diagn Interv Imaging. 2024 Oct 28:S2211-5684(24)00237-7. doi: 10.1016/j.diii.2024.10.005. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to assess the capabilities of MRI-based Node Reporting and Data System (Node-RADS) in diagnosing regional lymph node metastasis (RLNM) and to estimate its prognostic significance in patients with renal cell carcinomas (RCCs).

MATERIALS AND METHODS: Patients with RCC who underwent nephrectomy and regional lymph node dissection between January 2010 and August 2023 were retrospectively included. Two senior radiologists scored lymph nodes in consensus using MRI-based Node-RADS. The performance of MRI-based Node-RADS for the diagnosis of RLNM was estimated using area under receiver operating characteristic (AUC) curves and compared against size criteria. Three additional readers scored all lesions to assess interobserver agreement. Progression-free survival and overall survival were estimated and compared between patients with low (1-3) and high (4-5) scores.

RESULTS: Overall, 216 patients with RCC were enrolled, including 58 with RLNM. There were 157 men and 59 women with a median age of 54 years (range: 8-83 years). Node-RADS showed larger AUC (0.93 [95 % confidence interval (CI): 0.87-0.97]) and higher specificity (96.8 % [95 % CI: 92.8-99.0]) compared to size criteria (0.88 [95 % CI: 0.83-0.94] and 87.3 % [95 % CI: 81.1-92.1], respectively) for the diagnosis of RLNM (P = 0.039 and P < 0.001, respectively). Substantial interobserver agreement in Node-RADS scoring was obtained between the three readers (weighted κ, 0.75 [95 % CI: 0.69-0.80]). During a median follow-up of 56 months, patients with high Node-RADS score experienced poorer progression-free survival (P < 0.001) and overall survival (P < 0.001) than those with low Node-RADS score. At multivariable Cox regression analysis, Node-RADS was an independent variable associated with RCC prognosis after adjustment for confounders.

CONCLUSIONS: The MRI-based Node-RADS demonstrates notable performance in detecting RLNM and showed potential prognostic significance for RCCs.

PMID:39472219 | DOI:10.1016/j.diii.2024.10.005

J World Fed Orthod. 2024 Oct 28:S2212-4438(24)00069-9. doi: 10.1016/j.ejwf.2024.09.005. Online ahead of print.

ABSTRACT

BACKGROUND: While orthodontic miniscrews have been widely documented for their successful application, limited research exists on the stability and effectiveness of reused miniscrews. This systematic review aims to evaluate the stability and effectiveness of reused miniscrews in orthodontic treatments.

METHODS: An electronic search was conducted for studies published up to February 2024 across MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane CENTRAL. Additionally, gray literature sources and manual searches of prominent orthodontic journals from 2010 to 2023, were also examined. Studies that investigated the use of miniscrews after retrieval and sterilization involving both in vitro studies and clinical trials were included.

RESULTS: From 946 searched studies, 18 were finally included in our review. Thirteen studies investigated retrieved and sterilized miniscrews, while five examined unused and sterilized miniscrews to isolate the effects of sterilization. After performing a meta-analysis on in vitro studies, no significant difference in insertion, removal, or fracture torque between retrieved and unretrieved miniscrews was found, though sterilized miniscrews had a statistically significant increase in insertion torque without affecting fracture resistance. Meta-analysis of clinical studies revealed that retrieved miniscrews exhibited a significantly higher failure rate with a risk ratio of 0.46 (95% confidence interval = 0.24, 0.69), indicating a higher likelihood of failure on reuse.

CONCLUSION: There were no significant differences in insertion and fracture torque between new and reused miniscrews. However, reused miniscrews were associated with a higher failure rate. This outcome may be influenced by factors such as sterilization methods, insertion technique, and patient-specific anatomical considerations.

PMID:39472213 | DOI:10.1016/j.ejwf.2024.09.005