Tag: pubmed

J Chest Surg. 2022 Jul 13. doi: 10.5090/jcs.21.146. Online ahead of print.

ABSTRACT

BACKGROUND: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database.

METHODS: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision.

RESULTS: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263-2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266-0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib.

CONCLUSION: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

PMID:35822442 | DOI:10.5090/jcs.21.146

Am J Transplant. 2022 Jul 13. doi: 10.1111/ajt.17149. Online ahead of print.

ABSTRACT

Uterus transplantation (UTx) is an effective treatment option for uterine factor infertility. However, the need for immunosuppression and congenital renal anomalies that coexist with uterine agenesis in about 30% of women with Mayer-Rokitansky-Kuster-Hauser syndrome create a risk for renal dysfunction. We therefore examined renal function trajectory and related pregnancy complications in an international cohort of 18 UTx recipients from 9/2016-2/2020 who had at least one live birth. All UTx recipients had a diminution in their renal function that was apparent starting at 30 days posttransplant and in half the reduction in eGFR was at least 20%; the decrease in eGFR persisted into the early post-partum period. Half met criteria for Stage 1 acute kidney injury (AKI) as defined by the AKI Network criteria during their pregnancy. Overall, 28% of UTx recipients developed pre-eclampsia. eGFR was lower at embryo transfer and throughout pregnancy among those who developed pre-eclampsia, reaching statistical significance at week 16 of pregnancy. This effect was independent of tacrolimus levels. Mean eGFR remained significantly lower in the first 1-3 months after delivery. In the subgroup who reached 12 months of postpartum follow up and had a graft hysterectomy (n=4) there was no longer a statistical difference in eGFR (pretransplant 106.7ml/m ± 17.7 vs. 12 mos postpartum 92.6 ml/m ± 21.7, p=0.13) but the number was small. Further study is required to delineate long term renal risks for UTx recipients, improve patient selection and make decisions regarding a second pregnancy.

PMID:35822437 | DOI:10.1111/ajt.17149

Physiol Rep. 2022 Jul;10(13):e15380. doi: 10.14814/phy2.15380.

ABSTRACT

Abnormal postprandial suppression of glucagon in Type 2 diabetes (T2DM) has been attributed to impaired insulin secretion. Prior work suggests that insulin and glucagon show an inverse coordinated relationship. However, dysregulation of α-cell function in prediabetes occurs early and independently of changes in β-cells, which suggests insulin having a less significant role on glucagon control. We therefore, sought to examine whether hepatic vein hormone concentrations provide evidence to further support the modulation of glucagon secretion by insulin. As part of a series of experiments to measure the effect of diabetes-associated genetic variation in TCF7L2 on islet cell function, hepatic vein insulin and glucagon concentrations were measured at 2-minute intervals during fasting and a hyperglycemic clamp. The experiment was performed on 29 nondiabetic subjects (age = 46 ± 2 years, BMI 28 ± 1 Kg/m² ) and enabled post-hoc analysis, using Cross-Correlation and Cross-Approximate Entropy (Cross-ApEn) to evaluate the interaction of insulin and glucose. Mean insulin concentrations rose from fasting (33 ± 4 vs. 146 ± 12 pmol/L, p < 0.01) while glucagon was suppressed (96 ± 8 vs. 62 ± 5 ng/L, p < 0.01) during the clamp. Cross-ApEn was used to measure pattern reproducibility in the two hormones using glucagon as control mechanism (0.78 ± 0.03 vs. 0.76 ± 0.03, fasting vs. hyperglycemia) and using insulin as a control mechanism (0.78 ± 0.02 vs. 0.76 ± 0.03, fasting vs. hyperglycemia). Values did not differ between the two scenarios. Cross-correlation analysis demonstrated a small in-phase coordination between insulin and glucagon concentrations during fasting, which inverted during hyperglycemia. This data suggests that the interaction between the two hormones is not driven by either. On a minute-to-minute basis, direct control and secretion of glucagon is not mediated (or restrained) by insulin.

PMID:35822422 | DOI:10.14814/phy2.15380

Health Serv Res. 2022 Jul 13. doi: 10.1111/1475-6773.14027. Online ahead of print.

ABSTRACT

OBJECTIVE: To examine factors associated with racial inequities in discharge location, skilled nursing facility (SNF) utilization, and readmissions.

DATA SOURCES: A 20% sample of longitudinal Medicare claims from 2016 to 2018.

STUDY DESIGN: We present layered target matching, a method for studying sources of inequities. Layered target matching examines a fixed target population profile representing any race, ethnicity, or vulnerable population, sequentially adjusting for sets of characteristics that may contribute to inequities these groups endure. We use the method to study racial inequities in post-acute care use and readmissions.

DATA COLLECTION/EXTRACTION METHODS: We studied Black and Non-Hispanic White fee-for-service Medicare beneficiaries aged 66+ admitted to short-term acute-care hospitals for qualifying diagnoses or procedures between 1/1/2016 and 11/30/2018.

PRINCIPAL FINDINGS: Admitted Black patients tended to be younger, had significantly higher rates of risk factors such as diabetes, stroke, or renal disease, and were much more frequently admitted to large or academic hospitals. Relative to demographically similar White patients, Black patients were significantly more likely to be discharged to SNFs (21.8% vs. 19.3%, difference=2.5%, P<0.0001) and to receive any SNF care within 30 days of discharge (25.3% vs. 22.4%, difference=2.9%, P<0.0001). Black patients were also significantly more likely to experience 30-day readmission (18.7% vs. 14.5%, difference=4.2%, P<0.0001). Differences in reasons for hospitalization and risk factors explained most of the differences in discharge location, post-acute care use, and readmission rates, while additional adjustment for differences in hospital characteristics and complications made little difference for any of the measures studied.

CONCLUSIONS: We found significant Black-White differences in discharge to SNFs, SNF utilization, and readmission rates. Using layered target matching, we found that differences in risk factors and reasons for hospitalization explained most of these differences, while differences in hospitals did not materially impact the differences.

PMID:35822418 | DOI:10.1111/1475-6773.14027

Laryngoscope. 2022 Jul 13. doi: 10.1002/lary.30290. Online ahead of print.

ABSTRACT

OBJECTIVES: The clinical determination of vocal fold (VF) hypomobility based on laryngoscopy is subjective. Previous studies point to VF motion anomaly as the most commonly reported factor in the diagnosis of hypomobility. This study tested the hypotheses that VF angular velocities and angular range of motion (ROM) differ between the two VFs in cases of unilateral VF hypomobility.

STUDY DESIGN: Retrospective.

METHODS: Semi-automated analysis of laryngoscopic videos of 18 subjects diagnosed with unilateral VF hypomobility and 13 subjects with normal VF mobility was performed to quantify/compare the VF angular velocity and ROM between the two VFs during /i/-sniff and laugh.

RESULTS: In the hypomobile VF group, 7 out of 15 (47%) videos with /i/-sniff and 5 out of 8 (63%) with laugh had a statistically significant difference in the angular velocities between the VFs in either abduction or adduction. For VF ROM, 8 out of 15 (53%) /i/-sniff videos and 4 out of 8 (50%) with laughter had a statistically significant difference between VFs. In the group without the diagnosis of VF hypomobility, 9 out of 13 subjects (69%) had no difference in VF angular velocity and ROM during either /i/-sniff or laugh.

CONCLUSIONS: Differences in VF angular velocity or ROM are measurable in a substantial subset of subjects diagnosed with unilateral VF hypomobility. Clinicians’ ability to gauge VF motion goes beyond what can be extracted from frame-by-frame analysis. Other visual cues, in addition to VF angular velocity and ROM, likely contribute to the perception of unilateral VF hypomobility.

LEVEL OF EVIDENCE: 3 Laryngoscope, 2022.

PMID:35822396 | DOI:10.1002/lary.30290

Eur J Dent Educ. 2022 Jul 13. doi: 10.1111/eje.12836. Online ahead of print.

ABSTRACT

INTRODUCTION: Providing undergraduate dental students with a range of clinical experiences in fixed prosthodontics procedures is an important component of dental education. The aim of this retrospective study was to analyse the types of laboratory-fabricated fixed prosthodontics clinical units completed by undergraduate students over 10 consecutive years and determine any significant trends.

MATERIALS AND METHODS: The fixed prosthodontics treatment registers from 2012 to 2021 were reviewed and the different types of completed fixed prosthodontics units and total number of fixed prosthodontics units were recorded for each year. Completed units were categorised according to the type of restoration and expressed in whole numbers and as a percentage of the total number of units completed in each year. The data was presented in table and graph form. Mann-Kendall tests were performed to statistically analyse for trends in the different restoration types.

RESULTS: Throughout all study years, porcelain bonded to metal (PBM) crowns (48.25%, range 35.70% – 59.91%) were the most frequently completed fixed prosthodontics unit followed by full gold crowns (FGC) (20.84%, range 14.89% – 27.30%) and all-ceramic crowns (ACC) (12.70%, range 3.67% – 24.41%). Collectively, PBM, FGC and ACC comprised 81.80% of all completed fixed prosthodontics units. There were observed trends of increased use of all types of all-ceramic containing restorations, all types of all-gold containing restorations, all types of partial coverage restorations and specifically ceramic onlays and gold onlays. There were observed trends of reduced use of cast gold post-cores and all types of bridges.

CONCLUSION: PBM crowns were the mainstay laboratory-fabricated fixed prosthodontic unit completed over 10 years of undergraduate student fixed prosthodontics clinical practice.

PMID:35822395 | DOI:10.1111/eje.12836

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul;36(7):540-544;558. doi: 10.13201/j.issn.2096-7993.2022.07.012.

ABSTRACT

Objective:To investigate the effect of transoral endoscopic thyroid surgery in the central lymph node dissection of thyroid cancer. Methods:Twenty patients underwent endoscopic thyroidectomy via oral vestibular approach （TOETVA group） and 20 gender and age matched patients underwent conventional open thyroidectomy were selected in this study. The clinical data, number of lymph node dissection and postoperative complications of the two groups were collected and analyzed. SPSS 24.0 statistical software was used for data analysis. Results:There was no significant differences in age, BMI, tumor size or the number of Hashimoto’s thyroiditis patients between the TOETVA group and the open group（P>0.05）. The operation time（[117.30±10.54]min） and postoperative drainage volume（[146.05±30.66]mL） in the TOETVA group were significantly higher than those in the open group（[59.05±6.40]min, [77.90±22.18]mL）, P<0.001. The pain in the open group 24 h after surgery was more severe than that in the TOETVA group（P<0.05）. The total number of central lymph nodes, the number of pre-laryngeal lymph nodes and the number of pre-tracheal lymph nodes cleared by the two groups were similar, and the number of final positive lymph nodes had no significant difference. However, the number of paratracheal lymph nodes removed in the TOETVA group was more（7.8±4.2） nodes than that in the open group（6.4±3.9） nodes, P<0.05. There was no significant difference in postoperative complications between the two groups. The scores of cosmetic evaluation and rating of cicatrices in the TOETVA group six months after surgery were（0.77±0.58） significantly lower than those in the open group（4.30±1.54）, P<0.001. Conclusion:In central lymph node dissection, the efficiency of TOETVA is similar to that of traditional open thyroid surgery. For special anatomical regions, endoscopic surgery is more efficient. At the same time, TOETVA does not increase the incidence of related complications, and has good cosmetic effect.

PMID:35822383 | DOI:10.13201/j.issn.2096-7993.2022.07.012

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul;36(7):515-519. doi: 10.13201/j.issn.2096-7993.2022.07.007.

ABSTRACT

Objective:To investigate the characteristics of habitual sleeping position and triggered movement in patients with benign paroxysmal positional vertigo（BPPV）. Methods:The patients with idiopathic tubulitic BPPV who the symptoms were relieved after repositioning were enrolled in this study. The relationship between the side, the tube of otolith detachment and habitual sleeping position and triggered movement was analyzed. Results:①Among the 446 patients, female gender predominated（319 cases, 71.5%）, 41-60 years old group accounted for the highest proportion（192 cases, 43.0%）, and posterior semicircular canal patients accounted for the highest proportion（289 cases, 64.8%）; ②The affected side was associated with habitual sleep postion（P<0.05, ES=0.392）, ipsilateral ear was more common in left or right decubitus; ③There were statistically significant differences in the triggered movement in different types of BPPV（P<0.05, ES=0.380）, BPPV of multiple semicircular canals. Horizontal semicircular canals and posterior semicircular canals were more likely to induce vertigo and nystagmus. Conclusion:Habitual sleeping position and triggered movement could be collected during the diagnosis of BPPV, to predict the affected side and tube. The combination of Roll test and Dix-Hallpike test is more conducive to accurately distinguish the location of otolith shedding.

PMID:35822378 | DOI:10.13201/j.issn.2096-7993.2022.07.007

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jun;36(6):467-472. doi: 10.13201/j.issn.2096-7993.2022.06.012.

ABSTRACT

Objective:To analyzed allergens and screen for common airborne allergens in patients with allergic rhinitis （AR） in Shenzhen, and identified the distribution pattern of allergens in this region. We aimed to provide scientific and feasible statistical and clinical basis for prevention and treatment of allergenic rhinitis. Methods:For 3351 suspected cases of allergenic rhinitis, 18 kinds of airborne allergen serum-specific IgE were determined using a detection system of BioSciTec GmbH company, and statistical analysis was carried out according to sex, age, severity and seasonal allergen. Results:A total of 3,351 cases with allergic rhinitis were positive for airborne allergens. The top five inhalation allergens were Blomia tropicalis （2231, 66.6%）, Dermatophagoides pterronyssinus （2212, 66.0%）, Dermatophagoides farinae （1986, 59.3%）, Cockroach （967, 28.9%）, and Short ragweed （844, 25.2%）. For the severity of the allergen, Dermatophagoides pterronyssinus ≥ level 3 accounted for 41.3% （1385/3351 cases） and Dermatophagoides farinae ≥level 3 accounted for 40.6% （1360/3351 cases）. Blomia tropicalis were classified as level 2, and other allergens were mainly classified as level 1 or 2. The detection rate among different age groups and gender is significantly different. Conclusion:The main airborne allergens in Shenzhen were Blomia tropicalis, Dermatophagoides pterronyssinus, Dermatophagoides farinae, Cockroach, as well as Short ragweed. The distribution of allergens was affected by sex, age and season.

PMID:35822367 | DOI:10.13201/j.issn.2096-7993.2022.06.012

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jun;36(6):447-452. doi: 10.13201/j.issn.2096-7993.2022.06.008.

ABSTRACT

Objective:To explore the diagnostic value of American Society of Radiology Thyroid Imaging Reporting and Data System（ACR-TIRADS） and Chinese Thyroid Nodule Ultrasound Malignant Risk Stratification（C-TIRADS） in nodular Hashimoto thyroiditis and papillary thyroid carcinoma with Hashimoto thyroiditis. Methods:This retrospective analysis included 144 patients（204 thyroid nodules） accompanied by nodular Hashimoto thyroiditis or papillary thyroid carcinoma under the background of Hashimoto thyroiditis confirmed by surgical pathology examination in the First Affiliated Hospital of Hebei North University from August 2018 to May 2021, all nodules were examined by ultrasound, and 204 nodules were scored and graded according to the classification standards of ACR-TIRADS and C-TIRADS. The surgical pathological results were the gold standard. The receiver operating characteristic curve of ACR-TIRADS and C-TIRADS was constructed to evaluate and compare the diagnostic performance of the two guideline. Results:①Ultrasound feature results showed that nodular Hashimoto thyroiditis and Papillary thyroid carcinoma had statistically significant differences in the location, echogenicity, calcifications and margins（P<0.001）, but there is no significant difference in structure and aspect ratio between the two kinds of nodular（P=0.141, P=0.240）; nodular Hashimoto thyroiditis were mostly absent focal echogenicity and hyperechogenicity, while papillary thyroid carcinoma was mostly manifested as focal echogenicity and extrinsic thyroid invasion. ②The sensitivity and negative predictive value of C-TIRADS were 91.7% and 83.1%, respectively, which were higher than those of ACR-TIRADS, and the difference was statistically significant（P=0.021, P=0.013）; The specificity and positive predictive value of C-TIRADS T were 98.3% and 99.2%, both of which were slightly higher than ACR-TIRADS, althought the difference was not statistically significant（P=0.157, P=0.062）. The area under the curve of the ACR-TIRADS and C-TIRADS were 0.806 and 0.941, respectively, and the difference was statistically significant（P=0.031）. ③The unnecessary FNAB rate of C-TIRADS was 10.3%, which was lower than ACR-TIRADS. Conclusion:C-TI-RADS has a better diagnostic value of nodular Hashimoto thyroiditis and thyroid papillary carcinoma under the background of Hashimoto thyroiditis, which is helpful for clinical evaluation of such nodules.

PMID:35822363 | DOI:10.13201/j.issn.2096-7993.2022.06.008