Tag: pubmed

Actas Urol Esp (Engl Ed). 2022 Jun 15:S2173-5786(22)00028-2. doi: 10.1016/j.acuroe.2022.03.002. Online ahead of print.

ABSTRACT

OBJECTIVE: It has been described that thymoglobulin could increase the risk of infections and malignancies, in comparison to basiliximab. Leukopenia and thrombocytopenia are also more common within the first days after transplantation among thymoglobulin patients. Our objective was to analyze bleeding complications in this subset of patients.

MATERIAL AND METHODS: Bleeding complications were evaluated among 515 renal transplants carried out at our institution between 2012 and 2018. We compared patients treated with thymoglobulin (Group 1, N=91) with those treated with basiliximab (Group 2, N=424).

RESULTS: We found differences in platelet decrease: 95,142.2 (55,339.6) in Group 1 and 52,364.3 (69,116.6) in Group 2 (P=0.001), number of patients with severe thrombocytopenia (<75,000/mm³) (20.8% vs. 3.7%, P=0.001), number of blood units transfused (3.25 (0.572) vs. 2.2 (0.191, P=0.028) and percentage of patients that required surgery due to bleeding (18.2% vs. 7.7%, P=0.046). In a multiple lineal regression multivariable analysis (dependent variable was number of blood units transfused), only age [OR 0.037, 95% CI (0.003-0.070)] and type of immunosuppression [OR 1.592, 95% CI (1.38-2.84)] showed statistical significance.

CONCLUSIONS: The use of thymoglobulin in the perioperative transplantation period could increase bleeding complications. In our series, in the group of patients with thymoglobulin, severe thrombocytopenia was 6 times more frequent, and active bleeding that required surgery was also 2.5 times more frequent. One way to continue with the use of this immunosuppression agent, might be to adjust the dose instead of discontinuing it. The use of thymoglobulin should be a factor to consider in the postoperative period of these patients.

PMID:35717440 | DOI:10.1016/j.acuroe.2022.03.002

Sci Rep. 2022 Jun 18;12(1):10304. doi: 10.1038/s41598-022-14633-9.

ABSTRACT

The most accepted procedures as conversion for poor weight changes after sleeve gastrectomy (SG), are malabsorptive surgeries. This study was designed to evaluate the 5-year outcomes of One Anastomosis Gastric Bypass (OAGB) following SG due to weight loss failure and weight regain. From September 2014 to January 2017, totally 23 patients with a history of SG conversion to OAGB in terms of weight loss failure or weight regain who had completed their 5-year follow-ups were studied. Some obesity related co-morbidities containing type-2 diabetes (DM), hypertension (HTN), dyslipidemia, obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) were also investigated at 1, 2, 3 and 5 years after conversional surgery. All cases had remission/improvement in DM, DLP, HTN and OSA 1 year after conversional OAGB. Analysis showed statistically significant (P < 0.001) change in trend of BMI. Mean BMI before conversional surgery, at 1, 2, 3and 5 years were 46.3 ± 10.4, 34.5 ± 8.5, 34.1 ± 8.6, 35.7 ± 8.7 and 37.5 ± 11.6, respectively. Mean percent excess weight loss (%EWL) at 1, 2, 3 and 5 years was 51.6 ± 11.0, 52.9 ± 13.1, 45.5 ± 16.4 and 41.0 ± 18.0, respectively. Mean percent total weight loss (%TWL) at 1, 2, 3 and 5 years was 26.6 ± 5.9, 27.4 ± 7.2, 23.9 ± 9.2 and 20.9 ± 9.3, respectively. OAGB is an effective conversional procedure for insufficient weight loss and weight regain following failed SG and lead to satisfactory changes in obesity associated medical problems. The optimal weight loss results are obtained at 2-year follow-ups and these effects are then reduced.

PMID:35717435 | DOI:10.1038/s41598-022-14633-9

Clin Radiol. 2022 Jun 15:S0009-9260(22)00229-X. doi: 10.1016/j.crad.2022.04.020. Online ahead of print.

ABSTRACT

AIM: To examine the relationship between catheter tip location and catheter dysfunction in the context of tunnelled central venous catheters (CVCs) for haemodialysis.

MATERIALS AND METHODS: This was a retrospective study of 993 haemodialysis patients who underwent insertion of tunnelled CVCs of step-tip design via the right internal jugular vein (IJV). Based on intra-procedural radiographs, the catheter tip was characterised as being in the superior vena cava (SVC), cavo-atrial junction (CAJ), or deep right atrium (DRA). Patients were tracked for 90 days post-procedure for complications resulting in catheter replacement, and these were compared between cohorts. Statistical analysis was performed with Pearson’s chi-square and Fisher’s exact tests for categorical variables and two-sample t-test and one-way analysis of variance (ANOVA) for continuous variables.

RESULTS: Ninety-five patients (9.6%) experienced catheter dysfunction necessitating replacement within 90 days of insertion. Tip location in SVC was associated with lower occurrence of catheter dysfunction (1.9%) as compared with the CAJ (8%) and DRA (11%; p=0.049). Catheter replacement due to other complications (catheter-associated bacteraemia, cuff dislodgement, exit-site infection, external catheter damage) showed no statistically significant relation to location of the CVC tip.

CONCLUSION: When utilising tunnelled CVCs with a step-tip design inserted via the right IJV, location of the catheter tip in the SVC is associated with reduced occurrence of catheter dysfunction as compared to either the CAJ or DRA.

PMID:35717409 | DOI:10.1016/j.crad.2022.04.020

J Surg Educ. 2022 Jun 15:S1931-7204(22)00105-2. doi: 10.1016/j.jsurg.2022.05.002. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to explore the context and mechanisms by which the first set of Milestones impacted the processes of the Clinical Competency Committee, how programs have incorporated the Milestones into their program, and to understand more about the resident perspective in order to improve Orthopedic Surgery Milestones.

DESIGN, SETTING, AND PARTICIPANTS: In 2020 all 201 accredited orthopedic surgery residency programs were invited to participate in qualitative telephone interviews to assess their experience with the Milestones and complete a supplemental online survey about their Clinical Competency Committee. Participants were comprised of a self-selected sample and complemented by a purposeful sample to ensure a breadth of perspectives. Interview data were analyzed using template analysis. Survey data were analyzed with descriptive statistics.

RESULTS: Interviews were completed with 101 individuals from 47 programs (23% of all programs). The two overarching themes were implementation and impact of Milestones. Subthemes within implementation were substantial variability in approaches to Milestone use in curriculum and assessment, faculty development, and methods to introduce residents to the Milestones assessment framework. The large number of subcompetencies created a significant burden for almost all programs. The structure of the Milestones was also viewed as poorly aligned with the variable design of rotation schedules across programs. Milestones have the potential to offer valuable feedback for trainees and programs overall.

CONCLUSIONS/APPLICATION: While some benefits were noted and most programs appreciated the intent, the structure and design of the initial set of orthopedic surgery Milestones created substantial challenges for these programs. The results of this study helped guide a revision of the Orthopedic Surgery Milestones. These results can also be used by program leadership to encourage reflection around past, current, and future utilization of the Milestones framework. Further research will be needed to determine the impact of the revision on programs.

PMID:35717389 | DOI:10.1016/j.jsurg.2022.05.002

J Med Imaging Radiat Sci. 2022 Jun 15:S1939-8654(22)00280-6. doi: 10.1016/j.jmir.2022.05.008. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate and compare image quality and radiation dose between the helical and wide-volume scans to determine the protocol that provides a lower radiation dose without loss in image quality.

METHODS: The study was prospectively conducted on consented adult patients that presented for routine brain CT. Image quality and radiation dose were compared between the helical and wide-volume scans on the Toshiba 160-slice Aquilion Prime CT scanner. The volume computed tomography dose index (CTDIvol) and dose length product (DLP) for each scan mode were collected and compared. Image quality was quantitatively and qualitatively evaluated using the unenhanced brain CT images. The data were analysed using a statistical package for social sciences (SPSS) software version 20 for both the descriptive and inferential statistics. A significant difference in image quality and radiation dose between the helical and wide-volume scans was determined based on a p-value of <0.05.

RESULTS: A total of 54 participants were included, with two groups of 27 participants. The CTDI_vol and DLP values were significantly p < 0.05 higher in the helical scan (CTDI_vol: 65 mGy; DLP: 1597 mGy.cm) compared to the wide-volume scan (CTDI_vol: 54 mGy; DLP: 1133 mGy.cm). The grey and white matters show a better signal-to-noise ratio (SNR) for the helical scan. Meanwhile, the contrast-to-noise ratio (CNR) was significantly p < 0.05 higher in the wide-volume scan. The results from the visual grading methods were compared and showed superior image quality in helical over the wide-volume scan.

CONCLUSION: Wide-volume provides a lower dose compared to helical and therefore, could be adopted as the routine protocol for brain CT for in house dose optimisation. Where clinical conditions warrant the need for a helical scan, the protocol should be optimised in line with the as low as reasonable achievable (ALARA) principle.

PMID:35717379 | DOI:10.1016/j.jmir.2022.05.008

Infect Dis Poverty. 2022 Jun 18;11(1):70. doi: 10.1186/s40249-022-00995-9.

ABSTRACT

BACKGROUND: Due to sustained control activities, the prevalence of Schistosoma japonicum infection in humans, livestock and snails has decreased significantly in P. R. China, and the target has shifted from control to elimination according to the Outline of Healthy China 2030 Plan. Applying highly sensitive methods to explore the presence of S. japonicum infection in its intermediate host will benefit to assess the endemicity or verify the transmission interruption of schistosomiasis accurately. The aim of this study was to access the presence of S. japonicum infection by a loop-mediated isothermal amplification (LAMP) method through a 5-year longitudinal study in five lake provinces along the Yangtze River.

METHODS: Based on previous epidemiological data, about 260 villages with potential transmission risk of schistosomiasis were selected from endemic counties in five lake provinces along the Yangtze River annually from 2015 to 2019. Snail surveys were conducted in selected villages by systematic sampling method and/or environmental sampling method each year. All live snails collected from field were detected by microscopic dissection method, and then about one third of them were detected by LAMP method to assess the presence of S. japonicum infection with a single blind manner. The infection rate and nucleic acid positive rate of schistosomes in snails, as well as the indicators reflecting the snails’ distribution were calculated and analyzed. Fisher’s exact test was used to examine any change of positive rate of schistosomes in snails over time.

RESULTS: The 5-year survey covered 94,241 ha of environment with 33,897 ha of snail habitats detected accumulatively. Totally 145.3 ha new snail habitats and 524.4 ha re-emergent snail habitats were found during 2015-2019. The percentage of frames with snails decreased from 5.93% [45,152/761,492, 95% confidence intervals (CI): 5.88-5.98%] in 2015 to 5.25% (30,947/589,583, 95% CI: 5.19-5.31%) in 2019, while the mean density of living snails fluctuated but presented a downward trend generally from 0.20 snails/frame (155,622/761,492, 95% CI: 0.17-0.37) in 2015 to 0.13 snails/frame (76,144/589,583, 95% CI: 0.11-0.39) in 2019. A total of 555,393 live snails were collected, none of them was positive by dissection method. Totally 17 pooling snail samples were determined as positives by LAMP method among 8716 pooling samples with 174,822 of living snails, distributed in 12 villages of Hubei, Hunan, Jiangxi and Anhui provinces. The annual average positive rate was 0.41% (95% CI: 0.13-0.69%) in 2015, 0% in 2016, 0.36% (95% CI: 0.09-0.63%) in 2017, 0.05% (95% CI: 0-0.16%) in 2018, 0.05% (95% CI: 0-0.15%) in 2019, respectively, presenting a downward trend from 2015 to 2019 with statistical significance (χ² = 11.64, P < 0.05).

CONCLUSIONS: The results suggest that S. japonicum infection still persisted in nature along the Yangtze River and traditional techniques might underestimate the prevalence of schistosomiasis in its intermediate hosts. Exploring and integrating molecular techniques into national surveillance programme could improve the sensitivity of surveillance system and provide guidance on taking actions against schistosomiasis.

PMID:35717331 | DOI:10.1186/s40249-022-00995-9

J Dairy Sci. 2022 Jun 15:S0022-0302(22)00345-9. doi: 10.3168/jds.2022-22135. Online ahead of print.

ABSTRACT

Wildfires are particularly prevalent in the Western United States, home to more than 2 million dairy cows that produce more than 25% of the nation’s milk. Wildfires emit fine particulate matter (PM_2.5) in smoke, which is a known air toxin and is thought to contribute to morbidity in humans by inducing inflammation. The physiological responses of dairy cows to wildfire PM_2.5 are unknown. Herein we assessed the immune, metabolic, and production responses of lactating Holstein cows to wildfire PM_2.5 inhalation. Cows (primiparous, n = 7; multiparous, n = 6) were monitored across the wildfire season from July to September 2020. Cows were housed in freestall pens and thus were exposed to ambient air quality. Air temperature, relative humidity, and PM_2.5 were obtained from a monitoring station 5.7 km from the farm. Animals were considered to be exposed to wildfire PM_2.5 if daily average PM_2.5 exceeded 35 µg/m³ and wildfire and wind trajectory mapping showed that the PM_2.5 derived from active wildfires. Based on these conditions, cows were exposed to wildfire PM_2.5 for 7 consecutive days in mid-September. Milk yield was recorded daily and milk components analysis conducted before, during, and after exposure. Blood was taken from the jugular vein before, during, and after exposure and assayed for hematology, blood chemistry, and blood metabolites. Statistical analysis was conducted using mixed models including PM_2.5, temperature-humidity index (THI), parity (primiparous or multiparous), and their interactions as fixed effects and cow as a random effect. Separate models included lags up to 7 d to identify delayed and persistent effects from wildfire PM_2.5 exposure. Exposure to elevated PM_2.5 from wildfire smoke resulted in lower milk yield during exposure and for 7 d after last exposure and higher blood CO₂ concentration, which persisted for 1 d following exposure. We observed a positive PM_2.5 by THI interaction for eosinophil and basophil count and a negative PM_2.5 by THI interaction for red blood cell count and hemoglobin concentration after a 3-d lag. Neutrophil count was also lower with a combination of higher THI and PM_2.5. We found no discernable effect of PM_2.5 on haptoglobin concentration. Effects of PM_2.5 and THI on metabolism were contingent on day of exposure. On lag d 0, blood urea nitrogen (BUN) was reduced with higher combined THI and PM_2.5, but on subsequent lag days, THI and PM_2.5 had a positive interaction on BUN. Conversely, THI and PM_2.5 had a positive interacting effect on nonesterified fatty acids (NEFA) on lag d 0 but subsequently caused a reduction in circulating NEFA concentration. Our results suggest that exposure to high wildfire-derived PM_2.5, alone or in concert with elevated THI, alters systemic metabolism, milk production, and the innate immune system.

PMID:35717334 | DOI:10.3168/jds.2022-22135

Biomed Eng Online. 2022 Jun 18;21(1):40. doi: 10.1186/s12938-022-01007-5.

ABSTRACT

BACKGROUND: The minimum variance (MV) beamformer can significantly improve the image resolution in ultrasound imaging, but it has limited performance in noise reduction. We recently proposed the covariance matrix-based statistical beamforming (CMSB) for medical ultrasound imaging to reduce sidelobes and incoherent clutter.

METHODS: In this paper, we aim to improve the imaging performance of the MV beamformer by introducing a new pixel-based adaptive weighting approach based on CMSB, which is named as covariance matrix-based adaptive weighting (CMSAW). The proposed CMSAW estimates the mean-to-standard-deviation ratio (MSR) of a modified covariance matrix reconstructed by adaptive spatial smoothing, rotary averaging, and diagonal reducing. Moreover, adaptive diagonal reducing based on the aperture coherence is introduced in CMSAW to enhance the performance in speckle preservation.

RESULTS: The proposed CMSAW-weighted MV (CMSAW-MV) was validated through simulation, phantom experiments, and in vivo studies. The phantom experimental results show that CMSAW-MV obtains resolution improvement of 21.3% and simultaneously achieves average improvements of 96.4% and 71.8% in average contrast and generalized contrast-to-noise ratio (gCNR) for anechoic cyst, respectively, compared with MV. in vivo studies indicate that CMSAW-MV improves the noise reduction performance of MV beamformer.

CONCLUSION: Simulation, experimental, and in vivo results all show that CMSAW-MV can improve resolution and suppress sidelobes and incoherent clutter and noise. These results demonstrate the effectiveness of CMSAW in improving the imaging performance of MV beamformer. Moreover, the proposed CMSAW with a computational complexity of [Formula: see text] has the potential to be implemented in real time using the graphics processing unit.

PMID:35717330 | DOI:10.1186/s12938-022-01007-5

Environ Health. 2022 Jun 18;21(1):60. doi: 10.1186/s12940-022-00869-5.

ABSTRACT

BACKGROUND: The Italian mesothelioma registry (ReNaM) estimates mesothelioma incidence and addresses its etiology by assessing cases’ exposures but cannot provide relative risk estimates.

OBJECTIVES: i) To estimate pleural mesothelioma relative risk by industry and occupation and by ReNaM categories of asbestos exposure; and ii) to provide quantitative estimates of the exposure-response relationship.

METHODS: A population-based mesothelioma case-control study was conducted in 2012-2014 in five Italian regions. Cases and age and gender frequency-matched controls were interviewed using a standard ReNaM questionnaire. Experts coded work histories according to international standard classifications of industries/occupations and assigned asbestos exposure according to ReNaM categories. Job codes were further linked to SYN-JEM, a quantitative job-exposure matrix. Cumulative exposure (CE, f/mL-years) was computed by summing individual exposures over lifetime work history. Unconditional logistic regression analyses adjusted by gender, centre and age were fitted to calculate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS: Among men we observed increased risks of mesothelioma in many industries and associated occupations, including: asbestos-cement (OR = 3.43), manufacture of railroad equipment (OR = 8.07), shipbuilding and repairing (OR = 2.34), iron and steel mills (OR = 2.15), and construction (OR = 1.94). ORs by ReNaM exposure categories were as follows: definite/probable occupational exposure (OR = 15.8, men; OR = 8.80, women), possible occupational (OR = 2.82, men; OR = 3.70, women), sharing home with an exposed worker (OR = 2.55, men; OR = 10.3, women), residential (OR = 2.14, men; OR = 3.24, women). Based on SYN-JEM, mesothelioma risk increased by almost 30% per f/mL-year (OR = 1.28, CI 1.16-1.42).

CONCLUSIONS: Out study involved five regions with historically different types and levels of industrial development, encompassing one third of the Italian population and half of Italian mesothelioma cases. As expected, we found increased pleural mesothelioma risk in the asbestos industry and in trades with large consumption of asbestos materials. Clear associations were found using both qualitative (ReNaM classifications) and quantitative estimates (using SYN-JEM) of past asbestos exposure, with clear evidence of an exposure-response relationship.

PMID:35717324 | DOI:10.1186/s12940-022-00869-5

Eur J Surg Oncol. 2022 Jun 9:S0748-7983(22)00490-5. doi: 10.1016/j.ejso.2022.06.007. Online ahead of print.

ABSTRACT

INTRODUCTION: Surgery is the cornerstone of the treatment for advanced ovarian cancer. Reaching complete cytoreduction resulting in no gross residual disease often requires complex surgery. The aim of this study was to assess the impact of increased surgical radicality on the risk of complications in the treatment of advanced ovarian cancer.

MATERIALS AND METHODS: All consecutive patients with advanced ovarian cancer (FIGO Stage IIIB-IVB) who had undergone primary or interval debulking surgery during a six-year study period were identified. In the midst of the study period, a surgical practice change towards maximal surgical effort occurred. Two groups were formed for the analysis: cohort A, that consisted of patients operated before the surgical paradigm shift and cohort B, that consisted of patients operated under the period of increased surgical radicality.

RESULTS: 252 patients were included in the analysis. Complete resection (R0) was achieved in 21.3% of surgeries in cohort A and in 51.2% in cohort B. The total postoperative complication rate was 76.2%. Most of the complications (86.5%) were minor (Clavien-Dindo I-IIIA). The patients in cohort B were at increased risk for complications, OR 2.94 (95%CI 1.58-5.47; p = 0.001). As for the approach to cytoreduction (primary vs. interval debulking), there was no statistically significant association with the occurrence of postoperative complications (p = 0.659).

CONCLUSION: In the present study more extensive surgeries led to better surgical results but increased postoperative morbidity. Postoperative complication rates were similar in both primary and interval debulking surgeries.

PMID:35717320 | DOI:10.1016/j.ejso.2022.06.007