Tag: pubmed

Spine J. 2023 Apr 24:S1529-9430(23)00171-7. doi: 10.1016/j.spinee.2023.04.013. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Surgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed.

PURPOSE: To develop and validate a novel invasiveness index incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk.

STUDY DESIGN: A retrospective observational study.

PATIENT SAMPLE: Overall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included.

OUTCOME MEASURES: The operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses.

METHODS: We retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n = 692) were randomly placed in a training cohort, and the remaining 30% (n = 297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort.

RESULTS: The TII was more strongly correlated with operative time and estimated blood loss (P < 0.05) and explained more variability in operative time and estimated blood loss than the SII (P < 0.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (P < 0.05).

CONCLUSION: By incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.

PMID:37100245 | DOI:10.1016/j.spinee.2023.04.013

Arthroscopy. 2023 Apr 24:S0749-8063(23)00304-3. doi: 10.1016/j.arthro.2023.03.028. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate symptom duration and its relationship to patient reported outcomes and survivorship following hip arthroscopy in adolescents.

METHODS: Patients ≤18 at time of primary hip arthroscopy for FAI between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Minimum 2-year patient-reported outcomes (modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sport Scale (SSS), Short Forms 12 (SF-12)), minimum clinically significant difference (MCID) and patient acceptable symptom state (PASS) rates, and revision surgery rates, were compared based on symptom duration.

RESULTS: Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with mean age of 16.4±1.1 (range: 13.0-18.0). The mean symptom duration was 17.2±15.2 months (range: 43 days to 6.0 years). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3±1.0 years (range, 0.9 to 4.3 years). At a mean follow-up of 4.8±2.2 years (range, 2 to 10 years), there were statistically significant improvements in all PROs (p<.05 for all). Symptom duration showed no significant correlation to post-operative scores (correlation coefficient range: -0.162 to -.078, p>0.05 for all). Symptom duration <12 months versus >12 months or as a continuous variable was not a predictor for requiring revision surgery or achieving MCID/PASS (95% Confidence Interval crosses 1 for all).

CONCLUSION: In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in patient reported outcome measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable.

PMID:37100216 | DOI:10.1016/j.arthro.2023.03.028

Arthroscopy. 2023 Apr 24:S0749-8063(23)00303-1. doi: 10.1016/j.arthro.2023.03.027. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to 1) report on trends in immediate procedure reimbursement, patient out-of-pocket expenditures, and surgeon reimbursement in hip arthroscopy 2) compare trends in ambulatory surgery centers (ASC) versus outpatient hospitals (OH) utilization, 3) quantify the cost differences (if any) associated with ASC versus OH settings, and 4) determine the factors that predict ASC utilization for hip arthroscopy.

METHODS: The cohort for this descriptive epidemiology study was any patient over 18 years identified in the IBM MarketScan Commercial Claims Encounter database who underwent an outpatient hip arthroscopy, identified by Current Procedural Terminology codes, in the U.S. from 2013 to 2017. Immediate procedure reimbursement, patient out-of-pocket expenditure, and surgeon reimbursement were calculated, and a multivariable model was utilized to determine the influence of specific factors on these outcome variables. Statistically significant p-values were less than 0.05 and significant standardized differences were more than 0.1.

RESULTS: The cohort included 20,335 patients. An increasing trend in ASC utilization was observed (p=0.001), and ASC utilization for hip arthroscopy was 32.4% in 2017. Patient out-of-pocket expenditures for femoroacetabular impingement surgery increased 24.3% over the study period (p=0.003), which was higher than the rate for immediate procedure reimbursement (4.2%, p=0.007). ASCs were associated with $3310 (28.8%, p=0.001) reduction in immediate procedure reimbursement and $47 (6.2%, p=0.001) reduction in patient out-of-pocket expenditure per hip arthroscopy.

CONCLUSION: ASCs provide a significant cost difference for hip arthroscopy. While there is an increasing trend towards ASC utilization, it remains relatively low at 32.4% in 2017. Thus, there are opportunities for expanded ASC utilization, which is associated with significant immediate procedure reimbursement difference of $3,310 and patient out-of-pocket expenditure difference of $47 per hip arthroscopy case, ultimately benefiting healthcare systems, surgeons and patients alike.

PMID:37100212 | DOI:10.1016/j.arthro.2023.03.027

J Stomatol Oral Maxillofac Surg. 2023 Apr 24:101483. doi: 10.1016/j.jormas.2023.101483. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study evaluated the effect of two protocols of Pulsed Electromagnetic Field (PEMF) therapy on bone neoformation on calvaria critical defects in rats.

MATERIAL & METHODS: 96 rats were randomly divided into 3 groups: Control Group (CG; n=32); Test Group – PEMF 1 hour (TG1h; n=32) and Test Group – PEMF 3 hour (TG3h; n=32). A Critical-size Bone Defect (CSD) was surgically created in the calvaria of rats. The animals in the test groups were exposure to PEMF for 5 days a week. The animals were euthanized at 14, 21, 45 and 60 days. The specimens were processed for volume and texture (TAn) analysis, by Cone Beam Computed Tomography (CBCT) and histomorphometric analysis, RESULTS: Histomorphometric and volume analyses revealed that there was no statistically significant difference in the repair of bone defects between groups receiving PEMF therapy and CG. TAn revealed a statistically significant difference between the groups only for the entropy parameter, in which TG1h group presented a higher value compared to CG on 21 days. TG1h and TG3h did not accelerate bone repair in calvarial critical size defect and the parameters of PEMF should be considered.

DISCUSSION: This study showed that PEMF application on CSD in rats does not accelerate bone repair. Although literature showed a positive association in biostimulation on bone tissue with the parameters applied, studies with other PEMF parameters are essential to verify improving this study design.

PMID:37100171 | DOI:10.1016/j.jormas.2023.101483

J Surg Res. 2023 Apr 24;289:121-128. doi: 10.1016/j.jss.2023.03.027. Online ahead of print.

ABSTRACT

BACKGROUND: The topics of healthcare for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients and inclusion of LGBTQ+ health providers remain overlooked. Some specialties may be perceived as less inclusive to LGBTQ+ trainees. This study aimed to describe the perspectives of current medical students regarding LGBTQ+ education and the acceptance of LGBTQ+ trainees among different specialties.

MATERIALS AND METHODS: A cross-sectional voluntary and anonymous online survey was distributed through REDCap to all medical students (n = 495) at a state medical school. Medical students’ sexuality and gender identity were queried. A descriptive statistical analysis was performed, and the responses were classified into two groups: LGBTQ+ and non-LGBTQ+.

RESULTS: A total of 212 responses were queried. Of the respondents who agreed that certain specialties are less welcoming to LGBTQ+ trainees (n = 69, 39%), orthopedic surgery, general surgery and neurosurgery were identified most frequently (84%, 76%, and 55%, respectively). After analyzing sexual orientation as an influence on choosing a future specialty for residency, only 1% of non-LGBTQ+ students indicated that their sexual orientation influences their specialty of choice in comparison with 30% of LGBTQ+ students (P < 0.001). Finally, more non-LGBTQ+ students indicated that they believe they are receiving appropriate education on caring for LGBTQ+ patients as compared to LGBTQ+ students (71% and 55%, respectively, P < 0.05).

CONCLUSIONS: LGBTQ+ students are still hesitant to pursue careers in General Surgery as compared to their non-LGBTQ+ peers. The perception that surgical specialties are the least welcoming to LGBTQ+ students continues to be a concern for all students. Further strategies of inclusivity and their effectiveness need to be studied.

PMID:37099822 | DOI:10.1016/j.jss.2023.03.027

Pancreas. 2022 Nov-Dec 01;51(10):1427-1433. doi: 10.1097/MPA.0000000000002183. Epub 2023 Mar 7.

ABSTRACT

OBJECTIVES: RING finger protein 26 (RNF26) plays an essential role in determining malignant tumor growth, whereas the role of which in pancreatic cancer (PC) has not been reported. This study aimed to investigate the role of RNF26 in PC cells.

METHODS: The Gene Expression Profiling Interactive Analysis was applied to study the role of RNF26 in malignant tumors. The in vitro or in vivo cell proliferation assays were used to investigate the role of RNF26 on the PC. The protein-protein interaction network analysis was used to search the binding partner of RNF26. The Western blot was used to reveal whether RNF26 promoted RNA binding motif protein-38 (RBM38) degradation in PC cells.

RESULTS: The Gene Expression Profiling Interactive Analysis tool showed that RNF26 was overexpressed in PC. Repressing RNF26 expression decreased PC cells growth, but overexpression of RNF26 increased PC proliferation. Furthermore, we demonstrated RNF26 degraded RBM38 to promote PC cell proliferation.

CONCLUSIONS: RNF26 was abnormally increased in PC, and upregulated RNF26 was correlated with a poor prognosis. RNF26 enhanced PC proliferation by inducing RBM38 degradation. We identified a novel RNF26-RBM28 axis involved in the progression of PC.

PMID:37099788 | DOI:10.1097/MPA.0000000000002183

Pancreas. 2022 Nov-Dec 01;51(10):1292-1299. doi: 10.1097/MPA.0000000000002208.

ABSTRACT

OBJECTIVES: For population databases, multivariable regressions are established analytical standards. The utilization of machine learning (ML) in population databases is novel. We compared conventional statistical methods and ML for predicting mortality in biliary acute pancreatitis (biliary AP).

METHODS: Using the Nationwide Readmission Database (2010-2014), we identified patients (age ≥18 years) with admissions for biliary AP. These data were randomly divided into a training (70%) and test set (30%), stratified by the outcome of mortality. The accuracy of ML and logistic regression models in predicting mortality was compared using 3 different assessments.

RESULTS: Among 97,027 hospitalizations for biliary AP, mortality rate was 0.97% (n = 944). Predictors of mortality included severe AP, sepsis, increasing age, and nonperformance of cholecystectomy. Assessment metrics for predicting the outcome of mortality, the scaled Brier score (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.16-0.33 vs 0.18; 95% CI, 0.09-0.27), F-measure (OR, 43.4; 95% CI, 38.3-48.6 vs 40.6; 95% CI, 35.7-45.5), and the area under the receiver operating characteristic (OR, 0.96; 95% CI, 0.94-0.97 vs 0.95; 95% CI, 0.94-0.96) were comparable between the ML and logistic regression models, respectively.

CONCLUSIONS: For population databases, traditional multivariable analysis is noninferior to ML-based algorithms in predictive modeling of hospital outcomes for biliary AP.

PMID:37099769 | DOI:10.1097/MPA.0000000000002208

Ultrasound Obstet Gynecol. 2023 Apr 26. doi: 10.1002/uog.26234. Online ahead of print.

ABSTRACT

OBJECTIVES: The incidence of gestational diabetes mellitus (GDM) is increasing and is associated with adverse maternal, fetal and neonatal outcomes. Arterial stiffness (AS) is raised in pregnancies complicated by placental-mediated diseases such as pre-eclampsia. We investigated if AS is different between healthy pregnancies and women with GDM on different treatment modalities.

METHODS: We conducted a prospective longitudinal cohort study to assess and compare AS in pregnancies complicated by GDM with low-risk controls. AS, measured by pulse wave velocity (PWV) and brachial (BrAIx) and aortic (AoAIx) augmentation Index, was recorded using the Arteriograph® at four gestational windows: 24+0 to 27+6; 28+0 to 31+6; 32+0 to 35+6 and ≥36+0 weeks of gestation (windows W1-W4, respectively). Women with GDM were considered both as a single group, and as subgroups defined by treatment modality. Data were analyzed using a linear mixed model on each AS variable (log-transformed) with group, gestational windows, maternal age, ethnicity, parity, body mass index, mean arterial pressure and heart rate as fixed effects and individual as a random effect. We compared the group means including relevant contrasts and adjusted the p-values using the Bonferroni correction.

RESULTS: The study population comprised 155 low-risk controls and 127 with GDM, of whom 59 were treated with dietary intervention, 47 with metformin alone and 21 with metformin plus insulin. The two-way interaction term of study group and gestational age was significant for BrAIx and AoAIx (p<0.001), though there was no evidence (p=0.729) that mean AoPWV was different between the study groups. Women in the control group demonstrated significantly lower BrAIx and AoAIX at gestational windows W1-3 compared to the combined GDM group, but not at W4. Mean (95% CI) difference in log adjusted BrAIx was -0.37 (-0.52, 0.22), -0.23 (-0.35, -0.12), and -0.29 (-0.40, -0.18) at W1, W2 and W3, respectively. Mean (95% CI) difference in log adjusted AoAIx was -0.49 (-0.69, -0.3), -0.32 (-0.47, -0.18) and -0.38 (-0.52, -0.24) at W1, W2 and W3, respectively. Similarly, women in the control group also demonstrated significantly lower BrAIx and AoAIx compared with each of the GDM treatment subgroups (diet, metformin and metformin plus insulin) at W1-3. The increase in mean BrAIx and AoAIx seen between W2 and W3 in the women with GDM treated with dietary management was attenuated in the metformin and metformin with insulin groups, however the mean differences in BrAIx and AoAIx between these treatment groups were not statistically significant at any gestational window.

CONCLUSIONS: Pregnancies complicated by GDM demonstrate significantly higher AS compared to low-risk pregnancies regardless of treatment modality. Our data provides a basis for further investigation into the association of metformin therapy with changes in AS and risk of placental-mediated diseases. This article is protected by copyright. All rights reserved.

PMID:37099764 | DOI:10.1002/uog.26234

J Crohns Colitis. 2023 Apr 26:jjad075. doi: 10.1093/ecco-jcc/jjad075. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Technological advances have provided innovative, adaptive, and responsive models of care for inflammatory bowel diseases (IBD). We conducted a systematic review to compare e-health interventions with standard care in management of IBD.

METHODS: We searched electronic databases for randomized controlled trials (RCT) comparing e-health interventions to standard care for patients with IBD. Effect measures were standardized mean difference (SMD), odds ratio (OR) or rate ratio (RR), calculated using the inverse variance or Mantel-Haenszel statistical method and random-effects models. Version 2 of the Cochrane tool was used to assess the risk of bias. The certainty of evidence was appraised with the GRADE framework.

RESULTS: Fourteen RCTs (n=3111; 1754-e-health & 1357-controls) were identified. The difference in disease activity scores (SMD 0.09, 95% CI: -0.09-0.28) and clinical remission (OR 1.12, 95% CI: 0.78-1.61) between e-health interventions and standard care were not statistically significant. Higher QoL (SMD 0.20, 95% CI: 0.05-0.35) and IBD knowledge (SMD 0.23, 95% CI: 0.10-0.36) scores were noted in the e-health group, while self-efficacy levels (SMD -0.09, 95% CI: -0.22-0.05) were comparable. E-health patients had fewer office (RR 0.85, 95% CI: 0.78-0.93) and emergency (RR 0.70, 95% CI: 0.51- 0.95) visits, with no statistically significant difference in endoscopic procedures, total healthcare encounters, corticosteroid use, and IBD related hospitalization or surgery. The trials were judged to be high risk of bias or have some concerns for disease remission. The certainty of evidence was moderate or low.

CONCLUSION: E-health technologies may have a role in value-based care in IBD.

PMID:37099723 | DOI:10.1093/ecco-jcc/jjad075

Med Oral Patol Oral Cir Bucal. 2023 Apr 26:25889. doi: 10.4317/medoral.25889. Online ahead of print.

ABSTRACT

BACKGROUND: Oral squamous cell carcinoma (OSCC) is gradually increasing its incidence in our society. Unfortunately, this entity is diagnosed at an advanced stage in most patients, a fact that implies greater difficulty in its treatment and a worse prognosis. This systematic review aims to assess whether the cytokines IL-6, IL-8 and TNF-α are potential salivary biomarkers that allow early diagnosis of cancer.

MATERIAL AND METHODS: An electronic search was performed in three databases (Pubmed, Scopus and Web of Science). We used the following keywords: “salivary cytokines”, “saliva cytokines”, “salivary interleukins”, “biomarkers”, “oral squamous cell carcinoma” and “diagnosis”, combined with the Boolean operators “AND” and “OR”.

RESULTS: 128 publications were found and finally 23 articles were included in the review and 15 in the meta-analysis. It has been observed that the majority of OSCC patients express higher salivary concentrations of IL-6, IL-8 and TNF-α compared to the control (CL) and premalignant lesion (OPML) groups. It has also been observed that the different premalignant lesions do not have statistically significant differences in the salivary concentration of the cytokines, and on the other hand, differences have been observed between the different TNM stages. The meta-analysis has shown that the difference in concentration of IL-6, IL-8 and TNF-α is statistically significant between the CL group and the OSCC, and also between the CL group and OPML.

CONCLUSIONS: There is sufficient evidence to affirm that IL-6, IL-8 and TNF-α are useful salivary cytokines in the early diagnosis and prognosis of OSCC. Although future studies are necessary to establish greater reliability of these biomarkers and thus be able to develop a valid diagnostic test.

PMID:37099710 | DOI:10.4317/medoral.25889