Tag: pubmed

Pediatr Blood Cancer. 2023 Apr 7:e30346. doi: 10.1002/pbc.30346. Online ahead of print.

ABSTRACT

BACKGROUND: Youth with sickle cell disease (SCD) experience increased rates of neurocognitive and emotional difficulties. Cross-sectional studies suggest neurocognitive and emotional functioning are associated with health outcomes in SCD. We investigated whether neurocognitive and emotional factors predicted future pain-related healthcare utilization in children with SCD.

PROCEDURE: Total 112 youth with SCD between ages 7 and 16 years reported sociodemographics and completed measures of neurocognitive functioning and emotional well-being. The number of emergency department (ED) visits and hospitalizations for pain 1 and 3 years after enrollment were determined by chart review.

RESULTS: The mean age of participants was 10.61 years (standard deviation = 2.91), with most being female (n = 65; 58%). Eighty-three (74%) participants had either HbSS or HbSβ⁰ thalassemia. Regression analyses showed that attention significantly predicted ED visits and hospitalizations for pain at 1 and 3 years after enrollment (all p-values ≤ .017), such that poorer attention was associated with higher healthcare utilization. Lower emotional quality of life also predicted more ED visits for pain at 3 years (b = -.009, p = .013) and hospitalizations for pain at 3 years (b = -.008, p = .020).

CONCLUSIONS: Neurocognitive and emotional factors are associated with subsequent healthcare use in youth with SCD. Poor attentional control might limit implementation of strategies to distract from pain or could make disease self-management behaviors more challenging. Results also highlight the potential impact of stress on pain onset, perception, and management. Clinicians should consider neurocognitive and emotional factors when developing strategies to optimize pain-related outcomes in SCD.

PMID:37026487 | DOI:10.1002/pbc.30346

Stroke. 2023 Apr 7. doi: 10.1161/STROKEAHA.122.040529. Online ahead of print.

ABSTRACT

BACKGROUND: Anti-inflammatory therapies reduce recurrent vascular events in coronary disease. Existing studies have reported highly conflicting findings for the association of blood inflammatory markers with vascular recurrence after stroke leading to uncertainty about the potential of anti-inflammatory therapies after stroke and no consensus about the utility of measurement of inflammatory markers in current guidelines.

METHODS: We investigated the association between hsCRP (high-sensitivity C-reactive protein), IL-6 (interluekin-6), and recurrent major adverse cardiovascular events (MACE), and stroke from individual participant data from 8420 patients with ischemic stroke/transient ischemic attack from 10 prospective studies. We did within-study multivariable regression analyses and then combined adjusted risk ratio (RR) by random-effects meta-analysis.

RESULTS: During 18 920 person-years of follow-up, 1407 (16.7% [95% CI, 15.9-17.5]) patients had MACE and 1191 (14.1% [95% CI, 13.4-14.9]) patients had recurrent stroke. On bivariate analysis, baseline IL-6 was associated with MACE (RR, 1.26 [95% CI, 1.10-1.43]) and recurrent stroke (RR, 1.18 [95% CI, 1.05-1.32]), per unit increase log_eIL-6. Similar associations were observed for hsCRP (MACE RR, 1.19 [95% CI, 1.09-1.29]; recurrent stroke RR, 1.12 [95% CI, 1.04-1.21], per unit increase log_ehsCRP). After adjustment for vascular risk factors and treatment, independent associations remained with MACE (IL-6, RR, 1.12 [95% CI, 1.04-1.21]; hsCRP, RR, 1.09 [95% CI, 1.04-1.15]) and recurrent stroke (IL-6, RR, 1.09 [95% CI, 1.00-1.19]; hsCRP, RR, 1.05 [95% CI, 1.00-1.11]). Comparing the top with the bottom quarters (Q4 versus Q1), IL-6 (RR, 1.35 [95% CI, 1.09-1.67]) and hsCRP (RR, 1.31 [95% CI, 1.07-1.61]) were associated with MACE after adjustment. Similar results were observed for recurrent stroke for IL-6 (RR, 1.33 [95% CI, 1.08-1.65]) but not hsCRP (RR, 1.16 [95% CI, 0.93-1.43]).

CONCLUSIONS: Blood markers of inflammation were independently associated with vascular recurrence after stroke, strengthening the rationale for randomized trials of anti-inflammatory therapies for secondary prevention after ischemic stroke/TIA.

PMID:37026458 | DOI:10.1161/STROKEAHA.122.040529

J Magn Reson Imaging. 2023 Apr 7. doi: 10.1002/jmri.28698. Online ahead of print.

ABSTRACT

BACKGROUND: Preventing sepsis-associated acute kidney injury (S-AKI) can be challenging because it develops rapidly and is often asymptomatic. Probability assessment of disease progression for therapeutic follow-up and outcome are important to intervene and prevent further damage.

PURPOSE: To establish a noninvasive multiparametric MRI (mpMRI) tool, including T₁ , T₂ , and perfusion mapping, for probability assessment of the outcome of S-AKI.

STUDY TYPE: Preclinical randomized prospective study.

ANIMAL MODEL: One hundred and forty adult female SD rats (65 control and 75 sepsis).

FIELD STRENGTH/SEQUENCE: 9.4T; T₁ and perfusion map (FAIR-EPI) and T₂ map (multiecho RARE).

ASSESSMENT: Experiment 1: To identify renal injury in relation to sepsis severity, serum creatinine levels were determined (31 control and 35 sepsis). Experiment 2: Animals underwent mpMRI (T₁ , T₂ , perfusion) 18 hours postsepsis. A subgroup of animals was immediately sacrificed for histology examination (nine control and seven sepsis). Result of mpMRI in follow-up subgroup (25 control and 33 sepsis) was used to predict survival outcomes at 96 hours.

STATISTICAL TESTS: Mann-Whitney U test, Spearman/Pearson correlation (r), P < 0.05 was considered statistically significant.

RESULTS: Severely ill septic animals exhibited significantly increased serum creatinine levels compared to controls (70 ± 30 vs. 34 ± 9 μmol/L, P < 0.0001). Cortical perfusion (480 ± 80 vs. 330 ± 140 mL/100 g tissue/min, P < 0.005), and cortical and medullary T₂ relaxation time constants were significantly reduced compared to controls (41 ± 4 vs. 37 ± 5 msec in cortex, P < 0.05, 52 ± 7 vs. 45 ± 6 msec in medulla, P < 0.05). The combination of cortical T₂ relaxation time constants and perfusion results at 18 hours could predict survival outcomes at 96 hours with high sensitivity (80%) and specificity (73%) (area under curve of ROC = 0.8, J_max = 0.52).

DATA CONCLUSION: This preclinical study suggests combined T₂ relaxation time and perfusion mapping as first line diagnostic tool for treatment planning.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.

PMID:37026419 | DOI:10.1002/jmri.28698

J Dermatolog Treat. 2023 Apr 7:1-27. doi: 10.1080/09546634.2023.2200570. Online ahead of print.

ABSTRACT

BACKGROUND: Topical medication is the mainstay for treatment of mild psoriasis. However, dissatisfaction with topicals is common and rates of non-adherence are high. Assessing patients’ perspectives can help to identify unmet needs.

OBJECTIVE: Our aim was to investigate satisfaction of patients with psoriasis with topical therapy and to determine influencing factors.

METHODS: Patients were recruited from the Department of Dermatology, University Medical Center Mannheim, Germany. Satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication version 1.4 with the domains effectiveness, side effects, convenience, and global satisfaction (scale 0-100 each). The impact of sociodemographic and disease characteristics was determined by multivariate regression.

RESULTS: Averaged across the cohort (n = 122, mean age 52.5 years, 58.2% male), the side effects domain had the highest mean satisfaction score (89.7), followed by convenience (72.5), global satisfaction (60.8) and effectiveness (55.0). Comparing specific medications, combinations of corticosteroids and vitamin D analogues were rated best in effectiveness. Treatment satisfaction was influenced by age, partnership, ability to apply topicals independently, disease-related quality-of-life impairment, sole or adjunctive use of topicals and pruritus.

CONCLUSIONS: Participants were particularly satisfied with safety but rather dissatisfied with effectiveness of topicals. Topical therapy should be adapted to individual needs with special attention to effectiveness.

PMID:37026416 | DOI:10.1080/09546634.2023.2200570

Disabil Rehabil. 2023 Apr 7:1-6. doi: 10.1080/09638288.2023.2194682. Online ahead of print.

ABSTRACT

PURPOSE: Translate, investigate reliability, and construct validity of the Brazilian Early Activity Scale for Endurance (EASE).

MATERIALS AND METHODS: Translation followed the international guidelines. Test-retest reliability was tested by 100 parents of children with cerebral palsy (CP): 18 months-5 years and 6-11 years. To determine construct validity, 94 parents of typically children completed the EASE. Statistical analysis included Bland-Altman, Intraclass Correlation Coefficient (ICC), Internal Consistency, and Floor and Ceiling Effect.

RESULTS: The majority of the sample consisted of children with CP in GMFCS (IV-V). EASE showed good test-retest reliability for younger (ICC = 0.8) and excellent test-retest reliability for older children with CP (ICC = 0.9), and good internal consistency of 0.7 and 0.8 for the young and older group, respectively. Bland-Altman showed the bias close to zero, with no ceiling or floor effect. Regarding construct validity, younger children showed lower scores when compared to the older children. Endurance differed significantly between children with CP who were walking and those who were not walking and also for age groups. Children with CP showed lower endurance compared to typically participants in the same age group.

CONCLUSIONS: Brazilian EASE is reliable and valid to estimate endurance in children with CP. Results provide evidence of construct validity.

PMID:37026412 | DOI:10.1080/09638288.2023.2194682

Am J Epidemiol. 2023 Apr 7:kwad081. doi: 10.1093/aje/kwad081. Online ahead of print.

ABSTRACT

Monitoring morbidity and mortality in resurgences of respiratory infections has been underpinned with the epidemic of COVID-19 and poses significant challenges. For example, case fatality rates and deaths attributed to specific respiratory pathogens are known to suffer from significant biases undermining their comparability through time and space. As a result, it is difficult to evaluate the protective effect of public health interventions or quantify the impact of a resurgence to the general population through direct recording of COVID-19 related deaths. To overcome these limitations, it has been proposed that more robust less biased metrics, such as the all-cause deaths, can be used to monitor the effect of an epidemic over a population and over time. More specifically, metrics of excess mortality over time, which have been used for influenza surveillance in the past, are increasingly considered important for COVID-19 surveillance. Here, we discuss excess mortality surveillance focusing on standardised single-point and standardised cumulative metrics that allow comparability of excess mortality through space and time. We explain why z-score allows for comparison of excess mortality between countries and different periods, while cumulative z-score allows assessment of excess mortality over long periods. Our commentary re-iterates the importance of standardised statistics of excess mortality for COVID-19 surveillance as we move towards co-existence with SARS-CoV-2 that will allow drawing conclusions from best practices in different health systems and different periods.

PMID:37026399 | DOI:10.1093/aje/kwad081

Asia Pac J Clin Oncol. 2023 Apr 7. doi: 10.1111/ajco.13951. Online ahead of print.

ABSTRACT

AIM: The aim of our study was to assess the predictive value of controlling nutritional status (CONUT) score for the prognosis of prostate cancer.

METHODS: A total of 257 patients’ characteristics, prostate-specific antigen (PSA) values, biopsy, and pathological specimen features were all recorded. The CONUT score was calculated for each patient from three blood parameters: total lymphocyte count (TLC), serum albumin, and cholesterol concentrations. Spearman’s correlation coefficient was used to assess the correlation between the total CONUT score and the variables including age, body mass index, prostate volume, PSA, biopsy and pathological specimen features, and PSA-recurrence free survival (PSA-RFS) time. The Kaplan-Meier method and log-rank test were used for PSA-RFS analysis. Regression analyses were performed to assess the association between clinicopathological factors, the International Society of Urological Pathology (ISUP) upgrading, and biochemical recurrence (BCR).

RESULTS: Statistically significant differences were determined in pathologic ISUP grade, and total tumor volume between low and high CONUT score groups. Additionally, the high CONUT score group had a significantly higher BCR rate and lower PSA-RFS when compared with the low CONUT score group. A strong positive correlation between total CONUT score and pathologic ISUP grade and a moderate negative correlation between total CONUT score and PSA-RFS was determined. In multivariate analysis, a total CONUT score ≥2 had a statistically significant association with ISUP upgrading (odds ratio [OR] = 3.05) and BCR (3.52).

CONCLUSION: Preoperative CONUT score is an independent predictive factor for ISUP score upgrading and BCR in patients who undergo radical prostatectomy.

PMID:37026376 | DOI:10.1111/ajco.13951

Asia Pac J Clin Oncol. 2023 Apr 7. doi: 10.1111/ajco.13958. Online ahead of print.

ABSTRACT

Breast cancer was the most diagnosed malignant neoplasm and the second leading cause of cancer mortality among Chinese females in 2020. Increased risk factors and widespread adoption of westernized lifestyles have resulted in an upward trend in the occurrence of breast cancer. Up to date knowledge on the incidence, mortality, survival, and burden of breast cancer is essential for optimized cancer prevention and control. To better understand the status of breast cancer in China, this narrative literature review collected data from multiple sources, including studies obtained from the PubMed database and text references, national annual cancer report, government cancer database, Global Cancer Statistics 2020, and Global Burden of Disease study (2019). This review provides an overview of the incidence, mortality, and survival rates of breast cancer, as well as a summary of disability-adjusted life years associated with breast cancer in China from 1990 to 2019, with comparisons to Japan, South Korea, Australia and the United States.

PMID:37026375 | DOI:10.1111/ajco.13958

Neurol India. 2023 Mar-Apr;71(Supplement):S183-S188. doi: 10.4103/0028-3886.373625.

ABSTRACT

BACKGROUND: The standard therapy for glioblastoma (GBM) has been external beam radiotherapy (EBRT) with concomitant temozolomide (TMZ) given for six cycles, after maximum possible surgical resection although recurrences after chemoradiation are mostly in-field.

OBJECTIVE: To compare the effects of early GKT (without EBRT) along with TMZ to those receiving standard chemoradiotherapy (EBRT + TMZ) after surgery.

METHODS: This was a retro-prospective study on histologically proven GBMs operated at our center between January 2016 and November 2018. The EBRT group consisted of 24 patients who received EBRT + TMZ for six cycles. The GKT arm consisted of 13 consecutive patients who received Gamma Knife within 4 weeks of surgery along with lifelong temozolomide. Patients were followed up every 3 months with CEMRI brain and PET-CT. The primary endpoint was overall survival (OS) with progression-free survival (PFS) being the secondary endpoint.

RESULTS: At a mean follow-up of 13.7 months, the median overall survivals in GKT and EBRT groups were 11.07 and 13.03 months, respectively (HR = 0.59; P value = 0.19; 95% CI: 0.27-1.29). The median PFS for GKT group was 7.03 months (95% CI: 4.17-17.3) as compared to 11.07 months (95% CI: 5.33-14.03) for the EBRT group. There was no statistical difference in the PFS or OS between the GKT and EBRT groups.

CONCLUSION: Our study shows that Gamma Knife therapy (without EBRT) to residual tumor/tumor bed after primary surgery with concurrent temozolomide has similar progression-free (PFS) and overall survival (OS) rates when compared to conventional treatment (EBRT).

PMID:37026351 | DOI:10.4103/0028-3886.373625

Neurol India. 2023 Mar-Apr;71(Supplement):S146-S152. doi: 10.4103/0028-3886.373643.

ABSTRACT

BACKGROUND: Brain metastases are the most common brain tumors, being one of the most frequent neurological complications of systemic cancer and an important cause of morbidity and mortality. Stereotactic radiosurgery is efficacious and safe in the treatment of brain metastases, with good local control rates and low adverse effects rate. Large brain metastases present some issues in balancing local control and treatment-related toxicity.

OBJECTIVE: Demonstrating adaptive staged-dose Gamma Knife radiosurgery (ASD-GKRS) being a safe and effective treatment for large brain metastases.

MATERIALS AND METHODS: We retrospectively analyzed our series of patients treated with two-stage Gamma Knife radiosurgery for large brain metastases in [BLINDED], between February 2018 and May 2020.

RESULTS: Forty patients with large brain metastases underwent adaptive staged-dose Gamma Knife radiosurgery, with median prescription dose of 12 Gy and a median interval between stages of 30 days. At three-month follow-up, the survival rate was 75.0% with a local control rate of 100%. At six-month follow-up, the survival rate was 75.0% with a local control rate of 96.7%. The mean volume reduction was 21.81 cm³ (16.76-26.86; 95% CI). The difference between baseline volume and six-month follow-up volume was statistically significant.

CONCLUSIONS: Adaptive staged-dose Gamma Knife radiosurgery is a safe, non-invasive and effective treatment for brain metastases, with a low rate of side effects. Large prospective trials are needed to strengthen data obtained about the effectiveness and safety of this technique in managing large brain metastases.

PMID:37026346 | DOI:10.4103/0028-3886.373643