Tag: pubmed

Mil Med. 2022 Oct 22:usac320. doi: 10.1093/milmed/usac320. Online ahead of print.

ABSTRACT

INTRODUCTION: Transgender individuals have served openly in the U.S. Military since 2016. Official policies for transgender servicemembers continue to evolve, including approaches to physical fitness testing of transgender servicemembers. There is a paucity of scientific data regarding the effects of gender affirming hormone therapy (GAHT) on athletic performance for the past 24 months of treatment. Identification of expected trends in performance during and after gender transition is essential to allow for the development of appropriate military policy regarding when to assess servicemembers’ fitness by standards of their affirmed gender.

MATERIALS AND METHODS: We identified Department of the Air Force transgender patients using the Transgender Health Medical Evaluation Unit database and recorded dates of GAHT initiation through a retrospective chart review. We recorded performance values for the Air Force physical fitness test components 1 year before and up to 4 years after GAHT initiation. Performance measures were maximum sit-ups in 1 minute, push-ups in 1 minute, and 1.5-mile run time. Pre- and post-GAHT scores were compared using one-sample T-test to mean scores of Air Force-wide cisgender averages to assess for significant difference between affirmed transgender and cisgender airmen. We then performed the two one-sided test (TOST) procedure for equivalence with upper and lower bounds set at 1 SD from the means for cisgender airmen. Finally, using Z-scores, average transgender group scores were assigned a percentile rank with their respect to affirmed gender throughout the transition process.

RESULTS: Following initiation of GAHT, transgender males demonstrated statistically significant worse performance than cisgender males in all events until 3 years of GAHT. Their average scores would have attained a comfortable passing score within 1 year of GAHT. Transgender females’ performance showed statistically significantly better performance than cisgender females until 2 years of GAHT in run times and 4 years in sit-up scores and remained superior in push-ups at the study’s 4-year endpoint. TOST confirmed equivalence at all points where statistical difference was not demonstrated. Servicemembers approximate their pre-GAHT assigned gender percentile ranking in their affirmed gender in a manner consistent with hypothesis and TOST testing in the push-up event for both transgender males and females and in the 1.5-mile run event for transgender males.

CONCLUSIONS: In a sample of Air Force adult transgender patients, athletic performance measures demonstrate variable rates of change depending on the patients’ affirmed gender and differ by physical fitness test component. Based on this study, transgender females should begin to be assessed by the female standard no later than 2 years after starting GAHT, while transgender males could be assessed by their affirmed standard no earlier than 3 years after initiating GAHT.

PMID:36271916 | DOI:10.1093/milmed/usac320

Gynecol Endocrinol. 2022 Oct 22:1-6. doi: 10.1080/09513590.2022.2126453. Online ahead of print.

ABSTRACT

Background: The role of motile sperm count in intrauterine insemination (IUI) success rate is controversial. This retrospective cohort study performed among unselected infertile couples undergoing IUI was to explore the association between the total progressive motile sperm count (TPMSC) and the live birth rate (LBR) following IUI.Methods: The total cohort of 5363 cycles, 2666 infertile couples between January 2015 and December 2018 and finally 5171 cycles, 2647 couples were included for analysis in Sun Yat-sen memorial hospital of Sun Yat-sen University. The primary outcome was LBR per cycle. And the secondary outcome measure was clinical pregnancy rate (CPR) per cycle.Results: From the receiver operating characteristic (ROC) analysis of female age predicting live birth, female age cutoff was defined as 28 years. With a female age of ≤28 years, the CPRs were 11.5%, 14.9%, 16.1%, and 15.8% in quartile groups of pre-wash TPMSC, respectively. For the LBRs the values were 9.4%, 12.9%, 14.4%, and 11.3%, and there were also no significant differences in quartile groups of pre-wash TPMSC with ≤24 million (M), [24M-50M], [50M-97M], >97M. No statistically significant differences in the CPRs (p = .051) and LBRs (p = .088) were also observed in the quartiles groups of post-wash TPMSC. With a female age of >28 years, the CPR in couples with post-wash TPMSC ≤22.32 M was significantly lower than with post-wash TPMSC >81.0 M (p = .007). There was an obvious trend in which CPRs and LBRs increased with the post-wash TPMSC during the <81 M interval in women >28 years.Conclusions: The optimal female age cutoff for live birth was 28 years in IUI cycles. Pre-wash and post-wash TPMSC were not significantly associated with CPR and LBR per cycle. When female age >28 years, there was a better outcome with post-wash TPMSC >22.32 million.

PMID:36271782 | DOI:10.1080/09513590.2022.2126453

Clin Endocrinol (Oxf). 2022 Oct 22. doi: 10.1111/cen.14839. Online ahead of print.

ABSTRACT

CONTEXT: Aromatase inhibitor (AI) therapy provides oncological benefits in postmenopausal women with oestrogen-receptor positive breast cancer. However, AI treatment has been associated with increased cardiovascular risk. In non-breast cancer populations, experimentally-induced low oestrogen states and natural transition to menopause have been associated with increases in visceral adipose tissue (VAT), a known surrogate marker for cardiometabolic risk.

OBJECTIVE: Given that AI treatment blocks oestradiol production we hypothesised that AI treatment would increase VAT.

METHODS: We conducted a prospective 12-month cohort study of 52 postmenopausal women newly initiating AI treatment (median age 64.5 years) and 52 women with breast pathology not requiring endocrine therapy (median age 63.5 years). VAT area and other body composition parameters were measured at baseline, 6- and 12-months using Dual X-ray Absorptiometry. Other risk markers of cardiometabolic health were also assessed.

RESULTS: In women initiating AI treatment, there was no statistically significant difference in VAT area after 12-months when compared to controls, mean adjusted difference -5.00 cm2 (-16.9, 6.91), p=0.55. Moreover, changes in total fat mass, lean mass, subcutaneous adipose tissue area, hepatic steatosis and measures in endothelial function were also not statistically different between groups after 12-months. Findings were similar after adjustments for activity levels and COVID-19 lockdown duration.

CONCLUSIONS: These data provide reassurance that over the initial 12-months of AI therapy, AI treatment is not associated with metabolically adverse changes in body composition, hepatic steatosis or vascular reactivity. The impact of extended AI therapy on cardiometabolic health requires further study. This article is protected by copyright. All rights reserved.

PMID:36271726 | DOI:10.1111/cen.14839

Pharmacotherapy. 2022 Oct 22. doi: 10.1002/phar.2738. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: The aim of this study was to evaluate the effect on bleeding risk when fluconazole is administered concomitantly with direct oral anticoagulants (DOACs).

DESIGN: This was a retrospective cohort study including hospitalized adult patients prescribed a DOAC with or without fluconazole.

SETTING: The Ohio State University Wexner Medical Center, a tertiary care academic medical center with more than 1800 beds.

PATIENTS: Hospitalized patients ages 18 to 89 years who received apixaban or rivaroxaban with or without fluconazole from October 1, 2016 to September 30, 2021 were included. The minimum duration of DOAC or DOAC with fluconazole therapy was 48 hours. Patients were excluded if they received fluconazole <400 mg daily or a DOAC at doses outside those recommended for atrial fibrillation or venous thromboembolism treatment or prophylaxis. Patients were matched based on DOAC received.

INTERVENTION: Patients who received a DOAC with fluconazole were compared to those receiving a DOAC alone. The primary outcome was a composite of major, clinically relevant nonmajor, and minor bleeding events at 30 days.

MEASUREMENTS AND MAIN RESULTS: There were 216 patients included, 108 in the DOAC with fluconazole group and 108 in the DOAC alone group. More patients in the DOAC with fluconazole group experienced bleeding at 30 days compared to the DOAC alone group [35/108 (32%) vs. 21/108 (19%), respectively; p=0.03]; however, after adjusting for proven confounding variables (hemoglobin and concomitant carvedilol) this was found not to be statistically significant [adjusted odds ratio 1.71, 95% confidence interval 0.85 to 3.40].

CONCLUSIONS: Patients receiving a DOAC with fluconazole were not at significantly increased risk for bleeding at 30 days compared to those receiving a DOAC alone after controlling for confounding variables. As an increasing number of patients are prescribed DOACs, the results of this study may inform clinical decision-making on the safety of concomitant DOAC and fluconazole use.

PMID:36271717 | DOI:10.1002/phar.2738

Eat Disord. 2022 Oct 22:1-16. doi: 10.1080/10640266.2022.2135738. Online ahead of print.

ABSTRACT

Treatment outcomes in eating disorders (EDs) are still an open field for clinicians and researchers. Besides difficulties in egosyntonic-linked treatment engagements, dropout is one of the most crucial elements that cause a reduction in the treatment efficacy. Thus, the aim of this study is to evaluate factors that could contribute to high dropout rates and non-participation in follow-up evaluation in patients with ED. This study used a large sample of patients from a specialized ED ward and day hospital (DH). A sample of 428 individuals was recruited for this study. Psychological and demographic data were collected at the time of hospitalization and discharge from the facilities. These data were used to explore a possible link between dropout and follow-up non-participation. Specially, the random forest was used to rank demographic and psychological features in importance and evaluate the top results with regression analyses for statistical significance. A dropout rate of 12.14% during inpatient and DH treatment was found. Anger-hostility and general psychopathology were found to be predictors of dropout during treatment, while the duration of the hospitalization predicted non-participation at the six-month follow-up. Specific psychological features should be considered before and during treatments for patients with EDs to reduce dropout rates. The duration of the hospitalization should also be evaluated as a relevant healthcare element that could affect engagement and, accordingly, outcome.

PMID:36271711 | DOI:10.1080/10640266.2022.2135738

Asia Pac J Clin Oncol. 2022 Oct 21. doi: 10.1111/ajco.13878. Online ahead of print.

ABSTRACT

AIM: To evaluate the change in signal intensity (SI) and volume (V) from multiparametric magnetic resonance imaging (MRI) for assessing the response of locally advanced rectal cancer (LARC) to chemoradiotherapy (CRT).

MATERIALS AND METHODS: Eight-two LARC patients who underwent pre- and post-CRT T2-weighted (T2W), apparent diffusion coefficient (ADC), and contrast-enhanced T1-weighted (ceT1W) MRI were retrospectively analyzed. The change of volume (%△V) and relative SI ratio (%△SIR) from each sequence were determined. All LARCs were confirmed pathologically and classified as tumor regression grade (TRG) -0, 1, 2,or 3. Descriptive statistics and receiver operating characteristic (ROC) analysis, with calculation of area under the curve (AUC), were used to compare the diagnostic performances.

RESULTS: Sixteen patients had TRG-0, 15 had TRG-1, 35 had TRG-2, and 16 had TRG-3. Except for ADC-%△SIR, the remaining %△V and %△SIR values on MR sequences had significant differences among the four groups. The %△V and %△SIR (alone or together) did not distinguish TRG-1 from TRG-2, nor TRG-2 from TRG-3; however, differences between other TRGs were identified by %△V and %△SIR. The combined use of ADC-%△V and T2W-%△SIR provided the best diagnostic performance in distinguishing of TRG-0 from TRG-2 (AUC: 0.954) and from TRG-3 (AUC: 1.000).

CONCLUSIONS: Preoperative MRI of LARC patients after CRT has high diagnostic value for determination TRG, and may therefore improve the selection of patients most suitable for surgery.

PMID:36271652 | DOI:10.1111/ajco.13878

Acad Emerg Med. 2022 Oct 21. doi: 10.1111/acem.14612. Online ahead of print.

ABSTRACT

INTRODUCTION: Cluster surveillance, identification, and containment are primary outbreak management techniques, however, adapting these for low- and middle-income countries is an ongoing challenge. We aimed to evaluate the utility of prehospital call-center ambulance dispatch (CCAD) data for surveillance by examining the correlation between influenza-like illness-related (ILI) dispatch calls and COVID-19 cases.

METHODS: We performed a retrospective analysis of state-level CCAD and COVID-19 data recorded between January 1 and April 30, 2020, in Telangana, India. The primary outcome was a time-series correlation between ILI calls in CCAD and COVID-19 case counts. Secondarily, we looked for a year-to-year correlation of ILI calls in the same period over 2018, 2019, and 2020.

RESULTS: On average, ILI calls comprised 12.9% (95%CI: 11.7%-14.1%) of total daily calls in 2020, compared to 7.8% (95%CI: 7.6-8.0%) in 2018, and 7.7% (95%CI: 7.5-7.7%) in 2019. ILI call counts from 2018, 2019, and 2020 aligned closely until March 19, when 2020 ILI calls increased, representing 16% of all calls by March 23 and 27.5% by April 7. In contrast to the significant correlation observed between 2020 and previous years’ January-February calls (2020&2019: DW=0.749, p<0.001; 2020&2018: DW=1.232, p<0.001), no correlation was observed for March-April calls (2020&19: DW=2.012, p=0.476; 2020&2018: DW=1.820, p=0.208). In March-April 2020, the daily reported COVID-19 cases by time series significantly correlated with the ILI calls (DW=0.977, p<0.001). The ILI calls on a specific day significantly correlated with the COVID-19 cases reported seven days prior and up to 14 days after (cross-correlation >0.251, the 95% upper confidence limit).

CONCLUSIONS: The statistically significant time-series correlation between ILI calls and COVID-19 cases suggests prehospital CCAD can be part of early warning systems aiding outbreak cluster surveillance, identification, and containment.

PMID:36271649 | DOI:10.1111/acem.14612

Aliment Pharmacol Ther. 2022 Oct 21. doi: 10.1111/apt.17257. Online ahead of print.

ABSTRACT

BACKGROUND: Data reporting the heritability of non-alcoholic fatty liver disease (NAFLD) are highly variable.

AIMS: To investigate the association of NAFLD between parents and their adolescent children using a nationwide, population-based cohort.

METHODS: We analysed 1737 families with both parents and adolescent children aged 12-18 who participated in Korean National Health and Nutrition Examination Surveys (KNHANES) between 2010 and 2019. NAFLD was defined by body mass index and elevated alanine aminotransferase levels in children and by the hepatic steatosis index in parents.

RESULTS: The prevalence of NAFLD in adolescent children with either parent with NAFLD was higher than that in those without a parent with NAFLD (10.2% vs. 3.1%, p < 0.001). In a model fully adjusted for demographic, nutritional, behavioural and metabolic risk factors, children with either parent with NAFLD had a higher odds ratio (OR) for NAFLD (OR = 1.75, 95% CI: 1.02-3.00) than those without a parent with NAFLD. Compared to those without a parent with NAFLD, the fully adjusted ORs of NAFLD in children with paternal NAFLD, maternal NAFLD and NAFLD in both parents were 1.80 (95% CI: 1.01-3.20), 2.21 (95% CI: 1.11-4.42) and 2.60 (95% CI: 1.03-6.54), respectively.

CONCLUSION: Adolescent children with a parent with NAFLD were at increased risk of NAFLD; risk was higher when both parents had NAFLD. Further studies are needed to explore the benefit of NAFLD screening in children who have a parent with NAFLD.

PMID:36271616 | DOI:10.1111/apt.17257

New Phytol. 2022 Oct 21. doi: 10.1111/nph.18565. Online ahead of print.

ABSTRACT

Evolutionary relationships are likely to play a significant role in shaping plant physiological and structural traits observed in contemporary taxa. We review research on phylogenetic signal and correlated evolution in plant-water relations traits, which play important roles in allowing plants to acquire, use and conserve water. We found more evidence for a phylogenetic signal in structural traits (e.g., stomatal length, stomatal density) than in physiological traits (e.g., stomatal conductance, water potential at turgor loss). Although water potential at turgor loss is the most-studied plant-water relations trait in an evolutionary context, it is the only trait consistently found to not have a phylogenetic signal. Correlated evolution was common among traits related to water movement efficiency and hydraulic safety in both leaves and stems. We conclude that evidence for phylogenetic signal varies depending on 1) the methodology used for its determination, i.e., model-based approaches to determine phylogenetic signal such as Blomberg’s K or Pagel’s λ vs. statistical approaches such as ANOVAs with taxonomic classification as a factor; 2) on the number of taxa studied (size of the phylogeny); and 3) the setting in which plants grow (field vs. common garden). More explicitly and consistently considering the role of evolutionary relationships in shaping plant ecophysiology could improve our understanding of how traits compare among species, how traits are coordinated with one another, and how traits vary with environment.

PMID:36271615 | DOI:10.1111/nph.18565

Cancer Med. 2022 Oct 21. doi: 10.1002/cam4.5234. Online ahead of print.

ABSTRACT

BACKGROUND: The use of proteasome inhibitors (PIs), new immune modulators (IMiDs), and other new drugs, as well as high-dose chemotherapy combined with autologous stem cell transplantation has considerably improved the survival of young patients with multiple myeloma (MM). However, the improvement in survival among elderly patients remains insufficient. Optimal treatment recommendation models for elderly patients with MM have not been developed especially there are quite few study in the real world.

METHODS: We retrospectively analyzed the treatment patterns and outcomes of 328 Chinese patients (≥65 years) with MM in a real-world setting. Patients were divided into three groups according to induction regimens.

RESULTS: The median age of the cohort was 70 (65-86) years. The patients were divided into group 1 (PIs based regimens, n = 218), group 2 (IMiDs based regimens, n = 48) and group 3 (PIs + IMiDs, n = 62). Induction regimens in group 3 produced higher overall response rate than group 1 and 2 (85.42% vs. 71.08% vs. 66.67%, p = 0.016). The median follow-up of the cohort was 30 (interquartile range [IQR] 18-36) months. For the entire cohort median progression-free survival (PFS) was 26 (IQR 12.00-42.89) months and overall survival (OS) was 60 (IQR 40.00-67.20) months. The PFS were not significantly different among the three groups (28 months vs. 18 months vs. 26 months, p = 0.182). So were the OS (60 months vs. 59 months vs. not reached, p = 0.067). Multivariate analysis revealed that age >70 year, frailty status (Geriatric vulnerability score), induction efficacy < partial remission, and no maintenance treatment were independent poor prognostic factors for OS.

CONCLUSION: Front-line induction regimens combining PIs and IMiDs developed more deep response than single PI or IMiD based regimens. Maintenance treatment can further improve the clinical outcome in elderly MM patients in real-world setting.

PMID:36271592 | DOI:10.1002/cam4.5234