Tag: pubmed

Updates Surg. 2023 Sep 20. doi: 10.1007/s13304-023-01638-w. Online ahead of print.

ABSTRACT

Surgical resection is the main treatment for proximal gastric cancer, but there is no consensus on its reconstruction. We carried out a meta-analysis to evaluate the effects of double-tract reconstruction (DTR) and double-flap technique (DFT) on postoperative quality of life in patients with proximal gastric cancer. Systematic searches of PubMed, Web of Science, EBSCO, and the Cochrane Library were performed. Literature for the last 5 years was searched without language restrictions. The cutoff date for the search was 12 April 2023. Literature and research searches were conducted independently by two researchers and data were extracted. Statistical analyses were performed using Review Manager (Revman) 5.4 software. Fixed models were used when heterogeneity was small and random-effects models were used for meta-analysis when heterogeneity was large. The study was registered with PROSPERO, CRD 42023418520. Surgical time was significantly shorter in the DTR group than in the DFT group (P = 0.03). There were no significant differences between DFT and DTR in terms of age, gender, pathological stage, preoperative body mass index, surgical bleeding, and perioperative complications. There was no statistically significant difference between the two groups in terms of reflux esophagitis and PPI intake, but DFT was superior to DTR in weight improvement at 1 year after surgery (P < 0.0001). Compared with DTR, DFT reconstruction is more demanding and time-consuming, but its postoperative nutritional status is better, so it should be the first choice for GI reconstruction in most patients with early proximal gastric cancer. However, DTR should be the best choice for patients who have difficulty operating.

PMID:37728858 | DOI:10.1007/s13304-023-01638-w

Obes Surg. 2023 Sep 20. doi: 10.1007/s11695-023-06796-9. Online ahead of print.

ABSTRACT

BACKGROUND: Contrary to the previously known concept of muscle mass decrease following bariatric metabolic surgery, changes in muscle strength have been poorly investigated in systematic reviews. In this meta-analysis, we evaluated changes in handgrip strength (HGS) and lean mass (LM) after undergoing bariatric metabolic surgery.

METHODS: A systematic literature review using the PubMed, Embase, and Cochrane Library databases was conducted in November 2022. Longitudinal studies reporting HGS change after bariatric metabolic surgery were eligible. Pooled estimates for changes in HGS, body mass index (BMI), LM, and fat mass (FM) were calculated. Changes from baseline to the point closest to 6 months postoperatively were analyzed in trials with multiple follow-up examinations. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist.

RESULTS: Three randomized controlled trials and seven prospective cohort studies involving 301 patients were included. Follow-up evaluations were conducted 6 months postoperatively in all trials except for two, whose follow-up visits were at 18 weeks and 12 months, respectively. Pooled analysis showed reduced BMI (- 10.8 kg/m²; 95% confidence interval: – 11.6 to – 9.9 kg/m²), LM (- 7.4 kg; – 9.3 to – 5.4 kg), and FM (- 22.3 kg; – 25.1 to – 19.6 kg) after bariatric metabolic surgery, whereas the change in HGS was not statistically significant (- 0.46 kg; – 1.76 to 0.84 kg).

CONCLUSION: Despite the decreased body composition parameters, including muscle mass, strength was not impaired after bariatric metabolic surgery; this indicates that bariatric metabolic surgery is an effective weight management intervention that does not compromise strength.

PMID:37728838 | DOI:10.1007/s11695-023-06796-9

Acta Neurochir (Wien). 2023 Sep 20. doi: 10.1007/s00701-023-05793-2. Online ahead of print.

ABSTRACT

PURPOSE: This single center study aims to compare the treatment outcomes and procedure-related complications of coil embolization in elderly patients (60-79 years) and very elderly patients (aged 80 years or older) with cerebral aneurysms.

METHODS: Data was collected from 504 elderly patients aged 60 years or older who underwent coil embolization for intracranial aneurysms from 2018 to 2021. The study evaluated patient-related and anatomical factors and assessed various outcomes, comparing results between groups using statistical analysis and propensity score matching.

RESULTS: A total of 503 cerebral aneurysms were analyzed from individuals aged 60-79 years (n = 472) and those aged 80 years or older (n = 31). The majority of the aneurysms were unruptured with an average size of 3.5 mm in height and 3.4 mm in width. The patients were compared using 1:1 propensity score matching, and no significant differences were found in factors other than age and aortic elongation. Logistic analysis revealed that being over 80 years old and having a severe aortic arch elongation were identified as risk factors for procedure-related events in both total and unruptured cases.

CONCLUSIONS: The study compared coil embolization treatment for cerebral aneurysms in patients aged 60-79 and over 80, finding no significant difference in treatment outcomes except for procedure-related events. Procedure-related events were associated with severe aortic arch elongation and being over 80 years old. Coil embolization can be considered safe and effective for patients over 80, but further trials are needed for accurate conclusions.

PMID:37728829 | DOI:10.1007/s00701-023-05793-2

Prev Sci. 2023 Sep 20. doi: 10.1007/s11121-023-01587-1. Online ahead of print.

ABSTRACT

The stepped wedge design is often used to evaluate interventions as they are rolled out across schools, health clinics, communities, or other clusters. Most models used in the design and analysis of stepped wedge trials assume that the intervention effect is immediate and constant over time following implementation of the intervention (the “exposure time”). This is known as the IT (immediate treatment effect) assumption. However, recent research has shown that using methods based on the IT assumption when the treatment effect varies over exposure time can give extremely misleading results. In this manuscript, we discuss the need to carefully specify an appropriate measure of the treatment effect when the IT assumption is violated and we show how a stepped wedge trial can be powered when it is anticipated that the treatment effect will vary as a function of the exposure time. Specifically, we describe how to power a trial when the exposure time indicator (ETI) model of Kenny et al. (Statistics in Medicine, 41, 4311-4339, 2022) is used and the estimand of interest is a weighted average of the time-varying treatment effects. We apply these methods to the ADDRESS-BP trial, a type 3 hybrid implementation study designed to address racial disparities in health care by evaluating a practice-based implementation strategy to reduce hypertension in African American communities.

PMID:37728810 | DOI:10.1007/s11121-023-01587-1

Int J Cardiovasc Imaging. 2023 Sep 20. doi: 10.1007/s10554-023-02951-6. Online ahead of print.

ABSTRACT

Speckle tracking echocardiography (STE) derived longitudinal strain (LS) and noninvasive pressure-strain loop (PSL) derived myocardial work (MW) are more sensitive than conventional echocardiographic parameters in quantitative assessment of early myocardial dysfunction. The aim of this study was to assess left ventricular (LV) global and regional myocardial function in symptomatic chronic coronary syndrome (CCS) patients using the two promising methods. Transthoracic echocardiography was performed on patients with angina or equivalent symptoms before coronary angiography. STE-based LS and PSL-based MW analysis were carried out on each patient for global and regional myocardial function assessment. A total of 102 patients were classified into significant and nonsignificant coronary artery stenosis (CAS) groups. Among global myocardial function parameters, LS had the biggest area under the curve (AUC) of 0.735, with cutoff value of 18.4% (sensitivity, 79.6%; specificity, 72.9%), but remained statistically alike with all MW indices in predicting significant CAS (P>0.05 for all). Among regional myocardial function parameters, both LS and MW indices had predictive value for significant left anterior descending artery (LAD) or left circumflex artery (LCX) stenosis, while only myocardial work efficiency (MWE) for right coronary artery (RCA) stenosis. Both global and regional LS and MW have predictive value for significant CAS, but their value of regionalized assessment varies with specific coronary artery involvement.

PMID:37728801 | DOI:10.1007/s10554-023-02951-6

Dermatologie (Heidelb). 2023 Sep 20. doi: 10.1007/s00105-023-05220-8. Online ahead of print.

ABSTRACT

BACKGROUND: Neurofibromatosis type 1, also known as Recklinghausen’s disease, is a neurocutaneous tumor syndrome that is genetically determined and is associated with infestation of the integument with neurofibromas (nerve sheath tumors). The occurrence of neurofibromas can be very stressful for patients and often contributes to a reduced quality of life for patients, especially if externally visible body parts are affected. The aim of this study is to show to what extent the resection of cutaneous neurofibromas can improve patients’ quality of life.

MATERIALS AND METHODS: For this study, we conducted a retrospective data collection via questionnaire on the quality of life before and after the surgical removal of cutaneous neurofibromas at the Department of Dermatology, University Hospital of Tübingen. An adapted dermatological quality of life index and a postoperative questionnaire on patient satisfaction were used. In addition, patient data were taken from doctor’s notes, surgical reports, and outpatient documentation. A total of 30 patients with neurofibromatosis type 1 who underwent inpatient or outpatient surgery for cutaneous neurofibromas at the Tübingen dermatology hospital between 2016 and 2020 were surveyed. The survey results were statistically analyzed and represented as absolute and relative frequencies.

RESULTS: Our study indicates an improved quality of life after surgery for cutaneous neurofibromas, especially regarding limitations in everyday life, self-consciousness, the choice of clothing, and leisure activities. The majority of our patients showed no new occurrence of neurofibromas in the surgical area and postoperative bleeding or wound infections were rare.

CONCLUSION: In relation to the high level of satisfaction with the surgical and cosmetic results and also the positive influence on quality of life, our study indicates a favorable risk-benefit ratio for the resection of cutaneous neurofibromas in neurofibromatosis I.

PMID:37728798 | DOI:10.1007/s00105-023-05220-8

Graefes Arch Clin Exp Ophthalmol. 2023 Sep 20. doi: 10.1007/s00417-023-06236-5. Online ahead of print.

ABSTRACT

Diabetic retinopathy (DR) is the leading etiology of blindness in the working population of the USA. Its long-term management relies on effective glycemic control. Seven anti-diabetic classes have been introduced for patients with type 2 diabetes (T2D) in the past two decades, with different glucose-lowering and cardiovascular benefits. Yet, their effects specifically on DR have not been studied in detail. A systematic review of the literature was conducted to investigate this topic, focusing on the available clinical data for T2D. Published studies were evaluated based on their level of statistical evidence, as long as they incorporated at least one endpoint or adverse event pertaining to retinal health. Fifty nine articles met our inclusion criteria and were grouped per anti-diabetic class as follows: alpha-glucosidase inhibitors (1), peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists (8), amylin analogs (1), glucagon-like peptide-1 (GLP-1) receptor agonists (28), dipeptidyl peptidase 4 (DPP-4) inhibitors (9), and sodium glucose co-transporter-2 (SGLT-2) inhibitors (9), plus one retrospective study and two meta-analyses evaluating more than one of the aforementioned anti-diabetic categories. We also reviewed publicly-announced results of trials for the recently-introduced class of twincretins. The available data indicates that most drugs in the newer anti-diabetic classes are neutral to DR progression; however, there are subclasses differences in specific drugs and T2D populations. In particular, there is evidence suggesting there may be worse diabetic macular edema with PPAR-gamma agonists, potential slight DR worsening with semaglutide (GLP-1 receptor agonist), and potential slight increase in the incidence of retinal vein occlusion in elderly and patients with advanced kidney disease receiving SGLT-2 inhibitors. All these warrant further investigation. Longer follow-up and systematic assessment of at least one DR-related endpoint are highly recommended for all future trials in the T2D field, to ultimately address this topic.

PMID:37728754 | DOI:10.1007/s00417-023-06236-5

World J Urol. 2023 Sep 20. doi: 10.1007/s00345-023-04601-x. Online ahead of print.

ABSTRACT

BACKGROUND: With an increasing reliance on online sources for medical information, we studied the quality and completeness of health literacy videos on TikTok regarding BPH.

METHODS: A cross-sectional systematic evaluation of TikTok videos using the search term “Benign Prostatic Hyperplasia” was performed on 14th April 2023, and included 49 patient information and educational videos. The videos were then analysed by two reviewers and scored using two instruments: the DISCERN instrument and a completeness analysis.

RESULTS: Of the 49 videos, 38 were created by healthcare professionals (HCPs). The average length of each video was 62.7 ± 59.3 s, with a large average number of total views (24,990.1 ± 109,534.9 views). The DISCERN score trended higher in every category in videos published by HCPs compared to non-HCPs, with HCPs providing a statistically significant increase in reliability (19.0,14.6, p < 0.05) and total score (29.4,23, p < 0.05). Majority of videos were deemed as poor or worse (91.8%) in quality. The completeness of the videos’ content was also evaluated across five categories with an average score of 2.53 ± 2.1 out of the maximum 12. The DISCERN scores did not correlate with the degree of completeness of the videos (r = 0.226).

CONCLUSION: BPH videos on TikTok have a wide reach, but the videos are mostly of low quality and completeness. Future videos should be made with quality and completeness in mind given the large viewership and more can be done to evaluate the extent of BPH misinformation and its impact on patients.

PMID:37728744 | DOI:10.1007/s00345-023-04601-x

J Cancer Res Clin Oncol. 2023 Sep 20. doi: 10.1007/s00432-023-05400-y. Online ahead of print.

ABSTRACT

PURPOSE: Assessing the mortality rates associated with tobacco-related oral cancer (OC) is crucial for effective allocation of resources within healthcare and economic systems.

METHODS: In this study, data from the Global Burden of Disease Study (GBD) 2019 were utilized to analyze the burden of tobacco-attributable OC in China, the United States (US), and India from 1990 to 2019. Descriptive statistics and an age-period-cohort model were employed to examine and compare the effects on OC mortality.

RESULTS: 1. Attributable to tobacco, the deaths remained stable in the US, but increased in China and India. The trend of age-standardized mortality rate of OC increased in China, and decreased in the US and India, whereas the rate in India was the highest. 2. According to the APC model, the risk of death increased with age in all three countries. The period and later birth cohort effects were identified as risk factors in China and India, while in the US, the previous cohorts were identified as a risk factor. Except for India, males faced higher death risk than females in China and the US.

CONCLUSIONS: The burden of OC attributable to tobacco remains substantial in China and India. Public health officials in these countries should implement prevention and treatment strategies for OC, and interventions aimed at regulating the tobacco industry. The elderly is at an elevated risk for OC, and medical resources and policies should be directed toward this population. The successes experience in tobacco control and OC prevention in the US may serve as a model for other countries.

PMID:37728701 | DOI:10.1007/s00432-023-05400-y

Breast Cancer Res Treat. 2023 Sep 20. doi: 10.1007/s10549-023-07115-7. Online ahead of print.

ABSTRACT

PURPOSE: Breast cancer often metastasizes to the central nervous system. Although the prognosis of brain metastases from breast cancer has been considered poor, and systemic therapy has not contributed to an improved prognosis, newer agents are expected to be more effective. BRCAness is defined as the status of homologous recombination deficiency (HRD) in tumor tissue, regardless of the presence of pathogenic germline BRCA1/2 variants. A study employing next-generation sequencing analysis showed that HRD was found relatively frequently in brain metastases of breast cancer patients. However, there have been no studies evaluating BRCAness in brain metastases of breast cancer with more efficient, rapid, and cost-effective methods.

METHODS: We retrospectively investigated 17 brain metastases of breast cancer that were surgically resected at our hospital from January 2007 to December 2022. Of these, samples from 15 patients were evaluable for BRCAness by employing multiplex ligation-dependent probe amplification (MLPA) assay.

RESULTS: Of the 15 patients, five patients (33%) had tumors with BRCAness. Clinicopathological factors of patients with brain metastases with BRCAness were not statistically different from those of patients who possessed tumors without BRCAness. Patients with brain metastases with BRCAness had shorter overall survival compared to those without BRCAness (BRCAness, median 15 months (95% CI 2-30) vs. non-BRCAness, median 28.5 months (95% CI 10-60); P = 0.013).

CONCLUSION: In this study, we evaluated BRCAness in brain metastases of breast cancer with the MLPA method, and found that about one-third of patients had BRCAness-positive tumors. The analysis of BRCAness using MLPA has the potential for practical clinical use.

PMID:37728693 | DOI:10.1007/s10549-023-07115-7